‘How Could I Have Any More Children?’ : Brazil Tries to Turn Around ‘Chaotic’ Family Planning

Valeria married at age 16, had three children, and was sterilized by the time she was 20.

“I could barely feed the five of us on the $44 monthly minimum wage my husband brought home. How could I have any more children?” she told friends in Rio’s 200,000-strong Rocinha shanty town.

Valeria is one of an increasing number of younger women in Brazil who choose sterilization to prevent unwanted pregnancies because they do not believe they have any alternative.

“Tubal ligations have become a natural step in a growing number of poor younger women’s lives,” said demographer Sarah Hawker Costa.

But leaders of the world’s largest Roman Catholic nation have now decided to combat that trend--while at the same time ending a 20-year government philosophy that a large population means a strong country.

‘Extreme Poverty’

Overwhelmed by the needs of 60% of the 135 million population who live in “extreme poverty,” the 16-month-old civilian government recently implemented the first integrated family planning and women’s health program.

The program will give poor women access to sex education, counseling, health and free contraceptives, said spokesman Maria do Espirito Santo.

“We want to see women considered as a whole,” Espirito Santo said. “The new system will join family planning with womens’ health and mental well-being. We won’t promote population control.”

The program will turn around what one doctor described as 20 years of “perverse and chaotic” family planning in Brazil where about 30% of Brazilian pregnancies end in illegal abortions or miscarriages and maternal death is up to eight times higher than in developed countries.

“The public health system spends 40% of its obstetrical care budget to treat women suffering complications from $15 illegal abortions,” said Dr. Helio Aguinaga, president of Rio’s private family planning and women’s health care clinic known as CPAIMC.

‘Completely Chaotic’

“Family planning in Brazil has been completely chaotic,” Aguinaga said. “Pills were distributed, IUDs inserted, women sterilized without considering the ethics of the question.”

In Brazil, 42% of all births are by Caesarean section, or four to five times more than the World Health Organization says there should be.

In the last 21 years of military rule, poor women saw soaring inflation cut into family budgets and many wanted to limit their families.

But their alternatives were few.

Too frequently women relied upon strange potions of acids and herbs as well as self-inflicted abortions that often left them sterile, if not dead.

They could also turn to about 200 private internationally-funded organizations, the most far-reaching of which was the Social Welfare Society known as Bemfam, founded in 1965 with funding from Planned Parenthood. Bemfam set up clinics and health posts in poor communities nationwide, teaching mostly illiterate women about the basics of conception, health and birth control.

Abuses in Pill Use

But the group’s emphasis on population control instead of womens’ health sometimes led to abuses in pill use and sterilization, both of which were often offered free.

In the southern, industrial regions of Brazil, one-fifth of women were sterilized--40% between the ages of 30 and 39--while in the poor northeastern state of Piaui 56% of women between 15 and 44 were sterilized, Bemfam data showed.

A 1984 National Public Health School survey of seven Rio shanty towns showed that of the 64.9% of women using some sort of birth control, 34.7% were taking the pill and 20.7% had been sterilized.

By the late 1970s more than half of Brazilian women were already using some form of birth control.

The military regime began to question its opposition to population control in the early 1980s when it realized it had to turn away, usually because of malnutrition, over half the young men who signed up for mandatory two-year military service.

Crushing ‘All Development’

“This country will never improve itself by growing in this way. The mass acts like a steamroller that crushes all development,” former armed forces chief of staff Brigadier Waldyr Vasconcelos said in 1984.

The Brazilian Roman Catholic church similarly has softened its former stand against family planning as the root of immorality and sexual promiscuity.

Church leaders, confronted with 10 million to 15 million abandoned children, many of whom steal or beg to stay alive, and an infant mortality rate higher than that of most sub-Saharan African nations, will promote natural birth control such as the Billings and rhythm methods.

“It is easier and cheaper to cut the number of hungry mouths than to achieve a more just distribution of food,” Rio de Janeiro’s Cardinal Eugenio de Araujo Salles said last year.

But Aguinaga cautioned that the government program will not necessarily put women’s health first.

“Most public health service doctors know only what the drug companies and advertising agencies tell them about contraceptives,” Aguinaga said. “And we want to see family planning--not population control.”