Frustrated Demand for Postpartum Female Sterilization in Brazil

Ignez H.O. Perpétuo, Federal University of Minas Gerais
Elza Berquo, Comissao Nacional de Populacao e Desenvolvimento
Kristine Hopkins, University of Texas at Austin
Ondina Fachel Leal, Federal University of Rio Grande do Sul
Maria Celia de Carvalho Formiga, Universidade Federal do Rio Grande do Norte
Marta Rovery Souza, Universidade Estadual de Campinas

Fertility has declined in Brazil without large-scale organized family planning programs. During the last three decades, Brazilians have relied on the pill and female sterilization, with sterilization increasing over time. Until a new law was passed, sterilization was illegal and not covered by public nor private health insurance. It was frequently provided in public and private hospitals in conjunction with a cesarean. The new law regulating sterilization provided for reimbursement by public health insurance, but placed restrictions on availability intended to reduce the use of cesareans. This paper focuses on women's sterilization intentions during pregnancy and their experiences postpartum. In a prospective study of pregnant women, there was substantial demand for postpartum sterilization in both the private and public sectors. Public patients were less likely to be sterilized than private patients. Thus, the new law may not have reduced inequities in access or, paradoxically, the incentive for unnecessary cesarean sections.