Sterilization Rate Stirs Controversy : Public health: In Brazil the operation is illegal except to save the mother’s life. Nevertheless, it is routine. Many women use the surgery as birth control.
A dramatic increase in illegal sterilizations has led to congressional investigations and charges of discrimination against poor women.
It is occurring against a backdrop of poverty, ignorance and opposition by the Roman Catholic Church to artificial birth control.
“Sterilization is the easiest (birth control method) in a country like ours because there is no preparation or orientation,” said Lilibeth Ferreira, a Census Bureau researcher.
Twenty-eight percent of Brazilian women of childbearing age have been sterilized, according to a survey by the Institute for the Development of Resources in Washington, D.C. Only the Dominican Republic and El Salvador have higher rates.
The percentage of sterilized women in France is 5%, and in Sweden only 2%.
A 1987 Census Bureau survey showed sterilization was by far the leading type of birth control among Brazilian women, especially the poor. The most common form is tubal ligation, in which the Fallopian tubes are tied to prevent pregnancy.
Some officials of local governments promote sterilization. Several towns in Parana, a southern state, offer free tubal ligations for poor women with more than five children.
Chagas Alves, a state legislator and gynecologist in the northeastern city of Cascavel, has admitted personally sterilizing 750 poor women in 15 years.
In Rio, a state commission found many women base decisions to be sterilized on misleading information from doctors.
“Many women didn’t have any idea what had happened to their bodies,” said Sara Costa of the National School for Public Health. “They thought they could have children after the operation, without knowing the procedure is practically irreversible.”
Most sterilizations are voluntary, but many experts say poor women do not know any other way to avoid pregnancy. Federally sponsored family planning is practically nonexistent in this predominantly Catholic nation of 150 million.
Under military rule from 1964 to 1985, the government said family planning belonged in the “intimacy of the home.” In the 1970s, the generals encouraged big families to populate a nation larger than the contiguous United States.
In 1987, a government family planning program encountered opposition from church officials who claimed birth control would lead directly to abortion, divorce and promiscuity. The program, never generously financed, quietly died.
There is widespread ignorance of birth control. “I’ve heard condoms are used to prevent AIDS, but not to avoid having children,” said a shantytown resident who was trying to raise money for a tubal ligation.
Brazilian law forbids sterilization except in life-threatening situations. Doctors who perform the operation can be punished with up to eight years in prison, but the practice is routine, even in public hospitals.
Three-fourths of sterilizations are performed during Cesarean section births, the most common form of delivery.
“Doctors claim the Cesarean is necessary because of health risks,” said Audnes Tenorio of the Civil Society of Family Welfare, a private health organization. “Then they charge INAMPS (the federal health service) twice the rate for the delivery and the woman pays for the tubal ligation.”
Most contraceptive methods are too expensive in Brazil, where half the workers earn less than $120 a month.
“Many women have important reasons for not wanting to have children, but have no knowledge about other methods of birth control or no means of buying them,” Tenorio said. “Therefore, they seek the most radical solution.”
He said poor families often choose sterilization because they cannot afford more children.
“Most poor women have to work full-time and cannot pay for day care,” Tenorio said. “What are they supposed to do with their kids?”
Many experts dispute the common belief that fewer children mean less poverty. They note the average number of children per Brazilian family fell from 5.8 in 1970 to 3.3 in 1990, a period of general economic decline.
“The reason for Brazil’s poverty is income concentration, not population growth,” said Rep. Lucia Souto, who is leading the Rio state investigation. “The birth rate keeps dropping, but the country gets poorer and poorer.”
Especially troubling are census statistics showing an increase of sterilization among the young.
“Sterilization is not birth control, but a form of violence,” Souto said. “We don’t want Brazilian women to have a dozen children apiece, but we do want them to have options.”