Enabling Restrictions

Abstract

In Costa Rica today, where the use of contraceptives is widespread, the most popular method is female sterilization. Notably, Costa Rica’s high rates of this surgery were attained in the context of a very restrictive legal framework for the provision of sterilization. Until 1999, when a presidential decree explicitly regulated and permitted sterilization for contraceptive purposes, only therapeutic sterilization was legally allowed (i.e., to prevent a woman who had a serious health condition from becoming pregnant). Between 1970 and 1999, successive governments and state judicial bodies were unwilling to resolve the legal status of voluntary contraceptive sterilization. Government bureaucracies and different judicial branches repeatedly bounced the legal problem back to physicians to resolve. In the uncomfortable position of having to respond to an increasing demand for the surgery, specialist physicians responsible for sterilization, and their professional association, created a regulatory legal framework that ostensibly restricted the practice while actually enabling it. The provisions established by the professional association dictated access to sterilization in the country for over two decades, and were acknowledged not only by the population but also by state institutions, including those charged with surveying and protecting legality. A kind of judicial surrogacy was created in Costa Rica, though this surrogate role was not one Costa Rican physicians ever wanted, or felt comfortable playing.