In effect, at the heart of insularity are circumstances and conditions of structural inequality. Many low income Puerto Rican women seek to redress their disadvantaged situation through a collective insular bonding. They tend to reject a model of birth control that ultimately would give them more fertility options, and practice their traditional methods of birth control, which leads to early sterilization. In making their decision to sterilize, Puerto Rican women have made great strides in controlling their fertility and to a greater or lesser degree have taken modern action based on both culture and low income levels to legitimize sterilization as the most relied upon method of birth control in the Puerto Rican community. These Puerto Rican women base their decision to sterilize on personal motives and needs and a conviction that sterilization offers them an advantage.
Sterilization is effective and permanent, and it has no major side effects.
However, the permanence of sterilization can become a serious drawback for those who undergo the operation prematurely. Women who undergo the operation at too young an age have to face years without the possibility of having another child, even though their circumstances may change and they may wish to have more children. At the very least, Puerto Rican women who request sterilization should be advised of the possible consequence of making a premature decision. In essence, the decision to sterilize may appear to be without negative costs for the immediate but the actual result Is that they usually have eliminated any future birth decisions. In the final analysis, how Puerto Rican women make the decision to sterilize is clear.