In the past 40 years, Brazil has experienced rapid fertility decline, where the number of children per woman (i.e., total fertility rate) has dropped sharply from 6.0 in the 1960s to 2.3 in the late 1990s. What makes Brazil's fertility decline particularly interesting is its strong reliance on a nonreversible method of contraception: tubal ligation, here referred to as female sterilization. As recently as 1996, the country led the world in recorded rates of female sterilization. This practice is so pervasive and dominant that among some Brazilian scholars it has come to be called the surgical transition rather than the fertility transition. In this paper, we discuss the prevalence of female sterilization and other contraceptive methods among rural women of the Lower Amazon. The use of reversible (e.g., the pill, condoms) and irreversible (sterilization) methods is analyzed in terms of women's birth cohorts and in terms of their individual characteristics. We argue that to understand contraceptive choices we need to consider the social and cultural context, particularly the availability of local health services, the influence of doctors and politicians, as well as women's own goals for themselves and their children.