Pelo direito de decidir: autonomia reprodutiva e esterilização voluntária feminina em São José de Ribamar/MA

Abstract

This dissertation entitled “For the Right to Decide”: Reproductive Autonomy and Female Voluntary Sterilization in São José de Ribamar, Maranhão aimed to analyze how the materialization of reproductive rights through voluntary sterilization has contributed to the construction of female reproductive autonomy in the municipality of São José de Ribamar, Maranhão, focusing on its relationship with women’s reproductive autonomy. The study is grounded in the understanding that reproductive autonomy constitutes a fundamental dimension of sexual and reproductive rights and is directly related to the social, institutional, and cultural conditions that influence women’s decisions about reproduction. Although voluntary sterilization is a procedure guaranteed by Brazilian legislation and offered within the Unified Health System (SUS), obstacles that may hinder access to this right still persist. This is an analytical, qualitative study that used semi-structured interviews with women who sought or underwent voluntary sterilization and reside in São José de Ribamar. However, due to difficulties encountered in data collection, the study adopted a referral technique among participants known as the Snowball sampling method. The results made it possible to identify specific aspects related to the participants’ reproductive trajectories, the institutional pathways followed to access the procedure, structural barriers affecting the exercise of reproductive rights experienced along the way, as well as the strategies mobilized to ensure access to tubal ligation. The findings also indicate that, although there are institutional and bureaucratic barriers to accessing the procedure—such as gender inequalities and concrete limitations in access to alternative contraceptive methods—voluntary sterilization occupies a central place in these women’s reproductive trajectories. It is perceived as a “natural” choice that converges toward a possible autonomy, constructed within a restricted set of options. Female responsibility emerges as a strategic element in consolidating decisions previously built throughout life, enabling the prevention of pregnancy, greater control over economic conditions, and family organization. It is concluded that voluntary sterilization may represent an important instrument for the exercise of female reproductive autonomy, provided that it is framed within ethical, social, and political dimensions and guaranteed under equitable access conditions, with adequate information, professional healthcare support, access to reliable alternative contraceptive methods, respect for women’s decisions, and the strengthening of public policies for reproductive planning within the SUS and a secular State.