IN BRAZIL, STERILIZING WOMEN IS THE METHOD OF CHOICE
Christensen, Jon
POPULATION PATROL In Brazil, Sterilizing Women Is the Method of Choice BY JON CHRISTENSEN Aspectacular decline in Brazil's birth rate has provoked praise from international family-planning...
...The reason: In recent years, female sterilization has become the most popular form of birth control in Brazil and the principal factor behind a steady decline in the country's rate of population growth since the late 1970s...
...On the periphery of big cities such as Sao Luis, the poor simply can no longer afford to have more children...
...Into the vacuum, she says, rush private organizations that receive millions of dollars and contraceptives donated from the United States and Europe...
...The National Women's Rights Council calls for family-planning to be part of a comprehensive public-health program aimed at women...
...Some feminists put the estimate even higher, at four out of ten women...
...formed in public hospitals "scandalous...
...And there is'no parallel trend toward sterilization among Brazilian men...
...Last week a girl offered me two kids...
...The relatively high female sterilization rate in Brazil compares to a rate of only 8 per cent in neighboring Peru...
...They want to end poverty by preventing the poor from being born," says Eloni Bonotto, president of the Sao Luis Women's Union...
...Nationwide, health officials estimate that 27 per cent of married women between the ages of fifteen and forty-four have undergone tubal ligation...
...After giving birth to her second child recently, the twenty-three-year-old woman joined the legion of young Brazilian women opting for sterilization, a legion that includes her mother and a sister...
...In parts of the Amazon and in such poor northeastern states as Maranhao, they say the figure runs as high as 75 per cent...
...Maria Berenice Godinho Delgado, coordinator of the Central Workers Union's commission on women workers, claims that the International Monetary Fund has demanded reductions in Brazil's birth rate in exchange for renegotiation of its $ 115 billion debt...
...It's necessity," says Gomes...
...Now two-thirds use some form of contraception...
...The posts also distribute free birth-control pills and other contraceptives at minimal cost and will refer women to clinics that perform sterilizations...
...The doctors said I was bad for business...
...Eloni Bonotto was fired from her job as an anesthetist at the largest hospital in Sao Luis, the capital of the state of Maranhao, because she refused to participate in sterilizations...
...Nearly everyone has been steadily bombarded with the insistent modern cultural message that small families are better and enjoy a higher standard of living...
...Others submit to Cesarean deliveries, which are paid for by the public health system, in order to undergo sterilization, which is not covered...
...On a recent visit to the Guardian Angel slum, Bonotto met with Euzamar Perreira Santos, who grew up the eldest in a family of eight children...
...Many are organizing self-help clinics in poor neighborhoods to provide women with alternatives...
...In her new job as a public-health educator in the poor neighborhoods surrounding Sao Luis, Eloni Bonotto seeks to inform young women of family-planning alternatives and discourage them from jumping to the conclusion that sterilization is the answer...
...Like many other Brazilian feminists, Bonotto pins the blame for the high rate of sterilization on the absence of effective government-sponsored family-planning programs...
...And, in the absence of adequate health care and family-planning options, many of them have chosen the failsafe method, tubal ligation...
...Public-health services should provide access to all the reversible forms of contraception, the Council says, as well as the medical assistance necessary for each type...
...That Brazilian feminists now recognize the need for family planning is a departure from the 1960s, says Carmen Barroso...
...only 0.8 per cent have been sterilized...
...Back then, feminists were part of an anti-birth-control coalition that included everyone from conservative generals, who sought a population boom to occupy the Amazon, to the progressive wing of the Catholic Church, which became the principal arena for popular organizing during the dictatorship...
...Many feminists argue that an "ideology of control" rather than "choice" has dominated international family-planning efforts in Brazil...
...The largest of the private agencies, the Brazilian Society for Family Well-Being, or BEMFAM, has forty-four family-planning posts in Sao Luis alone and more than 2,500 nationwide...
...But she constantly runs up against the strength of a communications network that has probably done more to popularize sterilization than even television in Brazil—word of mouth passed from woman to woman, mother to daughter...
...IMF officials deny the charge...
...The Brazilian Catholic Bishops Conference branded the number of sterilizations person Christensen, a correspondent for Pacific News Service, spent 1989 in Brazil...
...The government should not be let off the hook, however, feminists argue...
...Changing values and the devastating collapse of the "Brazilian economic miracle" of the 1970s have made women turn in ever greater numbers to ways of limiting family size...
...Sitting in the bare living room of her rough brick house, Santos wonders what alternative she had...
...BEMFAM posts offer information on family planning, birth control, and prevention of sexually transmitted diseases...
...forty million are thought to live in "absolute misery" without adequate food, shelter, or health care...
...I said I couldn't take them...
...And every year, death claims nearly 260,000 babies before their first birthday...
...Many critics charge that women workers are being pressured to undergo sterilization in order to find and keep jobs...
...in the United States, it is 17 per cent...
...Some poor women save for nine months to pay for a tubal ligation at the end of a pregnancy...
...Santos says if she had known about all the alternatives, she might not have chosen sterilization at such a young age...
...I'm already struggling to raise these two...
...Thousands of independent women's groups, such as the Sao Luis Women's Union, have sprouted up around the country in recent years...
...More than half of Brazil's 140 million people live in poverty...
...Roughly half are performed in public clinics, in most cases on women during Cesarean deliveries...
...It is not done against women's will...
...I tried to tell the women that it was not the first option but the last," she says...
...Santos learned about sterilization when her mother had her tubes tied after bearing her eighth child...
...In what remains the world's largest Catholic country, the Church officially opposes any form of birth control other than abstinence and the rhythm method...
...Figures from the United Nations Population Division, which tracks international funding of family-planning efforts, indicate that about $46 million has been channeled from U.N...
...But not without raising a storm of controversy...
...Women can't feed their children because of the policies of the IMF and that leads them to limit their births with desperate moves...
...In Brazil, another factor has contributed to demographic change...
...A lot of women in this neighborhood have so many kids they give them away like dogs," she says...
...Some feminists charge that the First World is more interested in limiting Third World populations than in helping to eliminate their poverty...
...However, he does not believe the employers' practices cause the high rate of sterilization...
...POPULATION PATROL In Brazil, Sterilizing Women Is the Method of Choice BY JON CHRISTENSEN Aspectacular decline in Brazil's birth rate has provoked praise from international family-planning agencies and anger and controversy at home...
...Union officials report that the guarantee of a 120-day maternity leave in the 1988 constitution has led many businesses and industries to request proof of sterilization, pregnancy tests, and signed resignation letters that are kept on file for use if an employee becomes pregnant...
...To have another child year after year, a house filled with kids and misery, and us unable to feed and clothe them well...
...Our social conditions and limited family incomes lead to sterilization...
...Waiting lists for the operation are reported at many clinics...
...We have to accept part of the blame because we were against population control and not in favor of anything before," says Barroso...
...In contrast to countries where incentives and coercion have driven women to sterilization, Barroso says poverty and a lack of choice have determined the trend in Brazil...
...But she doesn't feel any regrets...
...The picture has changed dramatically since the mid-1960s, when the ruling military encouraged big families and only 5 per cent of couples used contraceptives...
...and nongovernmental sources to Brazilian agencies, both government and private, for a wide range of activities in recent years...
...But their will has no choice...
...More households have television sets than have running water...
...in China, where there are official birth-control incentives, 24 per cent...
...Nonetheless," says Carmen Barroso, a feminist health researcher at the Chagas Foundation in Sao Paulo, "the IMF has been important in crushing the country and subtracting real income from people through structural adjustments...
...Brazil suffered stagnant per-capita income—and declining real income for much of the population—throughout the 1980s...
...From clinics and family-planning posts throughout Brazil, she says, 135 different private agencies distribute free or low-cost contraceptives and encourage women to be sterilized...
...Coercion is institutionalized," she says...
...She says if she wants more children she'll adopt, but only after she finishes raising the two children she has borne...
...In such a politically charged atmosphere, the government has been reluctant to do much about family planning...
...Kleber Gomes, president of the Sao Luis Shopworkers Union, says most of the stores in the capital discriminate against female employees in one or more of these ways...
...Every year, more than 300,000 Brazilian women have their fallopian tubes tied, according to statistics from the Ministry of Health...
...The reduction in the number of births does not solve the growing level of misery in the population," the bishops warned in a pastoral document...
Vol. 54 • September 1991 • No. 9
