Legal barriers to voluntary sterilization are falling. In both developing and developed countries, new legislation, court decisions, government policy statements, and ministerial regulations increasingly leave the decision whether to be sterilized to the individuals involved rather than to medical experts or government officials. These legal changes confirm that voluntary sterilization is an acceptable means of fertility regulation and a legitimate medical procedure; it is no longer seen as physical mutilation to be condemned in the criminal codes. Nevertheless, barriers still exist in some countries that make it difficult for poor and rural populations to obtain voluntary sterilization. These obstacles arise when voluntary sterilization is excluded from national health and family planning programs and from private insurance plans. Changes in voluntary sterilization law reflect increasing choice of this method of fertility control. Over the last decade voluntary sterilization has become the most widely used means of family planning in the world. Approximately 100 million couples now are protected from unwanted pregnancy by voluntary sterilization. This amounts to one-eighth of the world's couples and one-third of all those practicing contraception. Almost half of these couples are in China. Voluntary sterilization is most prevalent in countries where the procedure has been clearly legal for a number of years. But now it is also becoming more common in countries like Brazil, where the legal status has been less clear.
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