Practices that emphasize reproductive health in Primary Health Care (PHC) in Brazil range from the provision of contraceptive methods to prenatal care, which are guided by protocols that aim to standardize them towards policies. Governance mechanisms, through these technocratic interventions, tend to regulate fertility and stimulate populational policies. In this study, we sought to understand the institutional management of reproductive health in PHC, based on the analysis of knowledge, expectations and representations surrounding the practices in question, from an intersectional perspective. This is an ethnographic study, carried out through participant observation and open interviews with professionals and users of a PHC facility located in Brazil, in the city of Rio de Janeiro. Stigmatization processes directed at young black women and those with “too many children” were revealed. The management of contraceptive means and methods contrasts the rhetoric of autonomic choices with the paradigm of the “contraceptive norm”, as women are fully responsible for their own fertility management. This management, otherwise, revealed itself to be contingent and permeated by ambivalences and “absences”. Tubal ligation appeared as an object of desire, metaphorized through the “Passport” as a document that authorizes women to perform it. LARC (long-acting reversible contraceptives), on the other hand, have its use encouraged by discourses on autonomy that appear to be, in reality, subsumed to the neo-Malthusian controlist paradigm. The present work revealed, therefore, tensions between choice and norm, autonomy and coercion, and care and control, through fertility regulatory mechanisms that take place in PHC, euphemized by the language of rights in contemporary times. These techniques occur in a bio-necropolitical matrix that authorizes and disauthorizes maternities, and, nevertheless, give rise to agencies on the part of users and also professionals, forged in power dynamics that articulate race, class, gender, territory and generation, especially in the Global South.