The contemporary discourse on Islamic bioethics, particularly concerning permanent sterilization (tubectomy and vasectomy), is characterized by a deep tension between classical jurisprudential norms and modern public health imperatives. This study investigates the institutional and sociological dimensions of fatwa authorities in Southeast Asia to understand how divergent methodologies (manhaj fiqh) produce either conservative or progressive rulings on reproductive autonomy. The problem centers on the observation that comparative studies of sterilization fatwas have traditionally focused on textual and legal outcomes, neglecting the underlying socio-political legitimacy, institutional structures, and epistemic frameworks of the fatwa-issuing bodies. This study focuses on how state and non-state religious authorities in Southeast Asia construct their sociological legitimacy. In what ways do differing approaches to maqāṣid al-sharīʿah influence the legal evolution of sterilization fatwas, and how do alternative, progressive authorities challenge hegemonic conservative paradigms? Employing a qualitative, socio-legal, and comparative doctrinal approach, this study synthesizes normative text analysis with the sociology of knowledge, utilizing library research and interviews to examine primary fatwa documents, historical policy shifts, and public health data. The findings reveal that institutional posture heavily dictates fatwa outcomes. Centralized, state-captured authorities maintain rigid, conservative prohibitions based on textual literalism. Semi-autonomous bodies demonstrate dynamic accommodation, transitioning from strict prohibition to conditional permissibility due to medical advancements in recanalization. Conversely, minority-context authorities utilize bioethical integration, while grassroots movements employ maqāṣid cum-mubādalah to center women's lived experiences. Ultimately, fatwas on sterilization are not merely products of divine text interpretation but are socially constructed instruments negotiated at the intersection of religious authority, medical legitimacy, and state population control.