POPULATION-BRAZIL: Four Out of 10 Women Sterilised

By Mario Osava Reprint | | Print |

Mario Osava

RIO DE JANEIRO, Sep 4 2003 (IPS) - As many as four out of 10 Brazilian women of child-bearing age have had their tubes tied, according to estimates that are widely accepted by experts.

That unusually high rate of sterilisation is due to ”a culture of tubal ligation,” which has become the preferred method of birth control, even among young women, said Dr. Antonio Carlos Rodrigues da Cunha, who has carried out research on the question at the University of Brasilia.

Cunha pointed out to IPS that in Italy, for example, less than one percent of women of child-bearing age have been sterilised.

The estimate that 40 percent of women of child-bearing age have undergone sterilisation surgery is based on studies by bodies like the Brazilian Federation of Associations of Gynecologists and Obstetricians.

A broad survey conducted among women between the ages of 15 and 49 by the Family Welfare Civil Society in 1996 found that of those who wanted to avoid pregnancy, 52 percent had opted for tubal ligation.

Around 80 percent of Brazilian women of child-bearing age use some method of birth control. But nearly all of them choose a hormonal method – either the pill or injections – or tubal ligation, in similar proportions, said Cunha, who stressed the need to diversify the alternatives and encourage the use of non-permanent contraception.

In the central-western states that make up Brazil’s new agricultural frontier, the rate of sterilisation among women is even higher, 59 percent. But experts note that this estimate is based only on the officially recorded cases, and that a large number of clandestine surgeries are carried out.

In the poorest parts of Brazil, political leaders frequently offer free sterilisation as part of their efforts to win votes.

A 1996 law ensures access to tubal ligation free of charge for women over 25 who have already had at least two children, or for even younger women who meet that requirement and are in stable marriages.

But the public health system cannot keep up with demand, Suzana Cavenaghi, a demographer at the University of Campinas, stated in a study carried out in hospitals and health clinics in six state capitals in the year 2000.

Of 77 pregnant women who requested the operation, only 30 ended up having their tubes tied, she reported.

Under the ”heavy pressure,” public hospitals apply their own eligibility criteria, by giving priority, for example, to older women and those who have more children, despite the fact that under Brazilian law, all women have the right to sterilisation surgery free of charge.

The rapid increase in the use of contraception in Brazil in the past few decades led to a drastic reduction of the annual population growth rate, from 2.89 percent in the 1960s to 1.64 percent in the 1990s.

But in many cases, women take the route of sterilisation out of ignorance about alternative birth control methods. That is reflected in the large number of women who seek tubal ligation reversal surgery, said Cunha in a study carried out among women who visited the University Hospital in Brasilia, the capital of this nation of 171 million.

Cunha found that half of the women who have their tubes tied at around the age of 25 later regret the decision, while many believe that reversing the procedure is as simple as ”untying” the fallopian tubes, and fail to realize that reversal is only successful in 50 percent of all cases.

A ”culture of sterilisation” began to emerge in Brazil in the 1960s, when ”women’s bodies became a stage on which political disputes played out,” Solange Rocha, projects coordinator at SOS Cuerpo (SOS Body), a women’s group in the northeastern state of Recife, told IPS.

She pointed out that in the 1960s and 1970s, the United States encouraged birth control in Latin America, with the idea that it would help prevent new Cuba-style revolutions. Brazil’s 1964-1985 military dictatorship, on the oth er hand, wanted to populate the country’s immense empty hinterland, for national security reasons, Rocha added.

The widespread sterilisation of women was the focus of several parliamentary investigative commissions between that era and 1991, said the activist.

In the 1980s, the movement for women’s rights successfully advocated the creation of a government programme for women’s health, with the aim of getting past the political use of family planning and establishing ”the idea of rights,” Rocha underlined.

But the sought-after ”change of paradigm” did not come about, she complained, and the practice of ”swapping tubal ligations for votes continues, due to the lack of solutions for fighting poverty.”

Poor women have little choice but to accept sterilisation, as they are not in a position to choose other methods of birth control, unlike middle-class women, who have a full range of alternatives, she said.

Women who undergo tubal ligations also face a higher risk of contracting HIV, the AIDS virus, as they feel less vulnerable, and because they can no longer use the birth control argument to pressure their husbands to use condoms, said Rocha.

In Brazil, HIV/AIDS is spreading especially fast among women, many of whom are in stable relationships and are infected by unfaithful partners.

Both Cunha and Rocha called for awareness-raising measures and greater information and education to enable women to choose between the various effective methods of preventing unwanted pregnancies.

The big problem, said Cunha, is that the poor continue to face serious difficulties in access to birth control, and to information on the different methods.

That means many women, even from the lowest socioeconomic strata, turn to private clinics, which charge at least 150 dollars for the operation in Rio de Janeiro, for example.

Dircilea da Silva Vieira, who works as a porter at a residential building in Rio de Janeiro, had her tubes tied at a private clinic 17 years ago, prior to passage of the law that made the operation available free of charge at public hospitals.

She underwent the procedure at age 30, after giving birth to her second child.

”My husband was opposed, and refused to sign the authorisation” form, but the clinic accepted ”the signature of one of my cousins,” Vieira told IPS.

”We couldn’t afford to have any more kids,” she said, adding that she chose sterilisation despite the fact that she was aware of other birth control methods.

Vieira said she has never regretted her decision, and that her husband eventually came around.

In Brazil, there is a marked difference in the proportion of women and men who have undergone sterilisation procedures. Less than three percent of men have had a vasectomy, compared to 12 percent of men in the United States, which is nearly half of the proportion of women who have had their tubes tied in that country, said Cavenaghi.