ABSTRACT
Despite being illegal and in the absence of any national family planning program, sterilization ranked as the method most popularly employed by Brazilian women for contraception in 1996. A full 40.1 percent of married women between the ages of 15-49 had been sterilized.2 In some of the poorer regions, it had reached rates as high as 59.9 percent and as low as 29 percent in some parts of the South.3 In the Northeast of Brazil, 70 percent of sterilizations were arranged and paid for by politicians and doctors.4 The percentage of sterilized women who had undergone the procedure before the age of 30 had reached 57 percent.5 This reliance in part on sterilization by women as a form of contraception had influenced a reduction of Brazil’s total fertility rate (TFR) by 45 percent between 1970-1990, to a TFR of 2, something that had taken Sweden and England more than half a century to do.6 This Brazilian story of over access is shared among demographers and family planning program officers. This excerpt pulled from my field notes tells an unexpectedly different story of access to sterilization in Brazil. Ivete’s case reveals that after legalization of the method of sterilization and the implementation of a national family planning program, sterilizations are not easily accessible for all. Women who have tried other contraceptive methods and do not want to have more children find it difficult to permanently end their fertility. Ivete went to the clinic to find out if she could get a tubal ligation-or other options-since her IUD had expired and she did not want more children. One analysis of Ivete, and other women’s stories similar to this one, would be that of class-those that are poor have less access when the public health system fails. I draw our attention beyond class, to the question of race, which so often has been
ignored in studies about sterilization in Brazil. In my interrogation of a reading that is reluctant to see race, I ask us to examine the connections between legality, race, and poverty more generally. At the same clinic where I met Ivete, Centro de Pesquisa e Assistência em Reprodução Humana (CEPARH), I interviewed a gynecologist.7 When asked about the criteria for a woman to get a tubal ligation and whether a woman of 30 years of age with one or no children could get sterilized, she responded with the following:
The criteria. She has to have a stable union. She has to have. . . Because here you have the Brazilian laws. It’s not just us that do, right? You have the law. You have to have a stable union. You have to have sixty days from the date that one chooses for the surgery. So that, so that you don’t have the chance of regretting. Think well and she has to have at least two children. Here, if she were to be twenty-five years old with three or two children and be thirty. If a girl arrives here, nineteen years of age and two children we don’t tie because she’s not adequate, right? Now, if a thirty year old woman or a thirty-five year old woman with two children arrives, there, she is within our criteria.8
