THE RELIGIOUS CONSULTATION
on population, reproductive health & ethics

Washington Post, June 11, 2004

Infertile Ground Is Sown in Brazil; Politicians Trade Sterilizations for Votes

BYLINE: Jon Jeter, Washington Post Foreign Service

SALVADOR, Brazil -- Claudia Barboza Santos did not share the politics of Mauricio Trinidade, the man who was able to help her. But she turned to him anyway. She was 29, unemployed, broke and the mother of one child. She did not want to have a second child.

Trinidade, a local councilman, was running for the Bahia state legislature. He wanted her vote. So they made a deal five years ago, and each got what they wanted: Trinidade arranged a sterilization procedure for Santos, and she voted for him.

"I didn't have a job, I was living with my parents and I knew it would be a big burden to have any more children," said Santos, who is now 34 and makes her living selling bootleg CDs. "My friends had all gone to" Trinidade for "help with their surgery, so when I decided it was time, I knew who to see. . . . All he wants is your vote."

Santos lives in the municipality of Pernambues in an area of redbrick hovels, junked cars and soft, sloping earth. Trinidade promises mostly poor, black women -- who are both old enough to cast a ballot and bear children -- free tubal ligations, a surgical procedure that renders them infertile.

With municipal elections again approaching in October, Trinidade and other politicians have posted campaign posters publicizing their help in family planning services. And virtually every day in poor neighborhoods in this northeastern city, vans bearing the candidates' names patrol the streets, arranging free sterilizations for women like Santos. They turn out in droves.

Brazilian women are having fewer children. The fertility rate has decreased from 4.3 children per woman in 1980 to about 2 children now, according to government statistics. Nearly one in two Brazilian women of childbearing age have been sterilized, according to a 2001 government survey. Demographers and health experts believe the figure is even higher.

"We have a culture of sterilization in Brazil," said Jurema Werneck, executive director of Criola, a women's health organization here in Brazil. "It's nationwide. A lot of politicians are elected because of their sterilization promises."

Brazil's efforts have led to increased criticism from women's health organizations, civil rights agencies and relief workers who argue that sterilization is an ineffectual anti-poverty tool. They also contend that sterilization programs feed racist notions about who should have children and who should not.

It is evident that the poor Brazilian women who have undergone tubal ligations remain poor. Women's groups say that many women later regret their contraceptive choices, and that the decision is costly to reverse and not 100 percent effective. Such organizations have staged anti-sterilization protests over the past decade. A federal law passed in 1997 requires that all women who undergo the procedure be either 25 years old or have at least two children.

"You don't solve poverty by reducing family size," Werneck said. "You solve poverty by expanding the economy through greater educational opportunities, through land reform. You have to create opportunities for women, not restrict them. There are far too many black women who are told that the only effective method of contraception is sterilization. Some people are quite well meaning in this notion, but there is a racist ideology behind it."

Catia Helena Bispo, who is black, a teacher and the former director of a community organization in Pernambues, said that many employers -- reluctant to hire women who may take time off for maternity leave -- require women to prove they have been sterilized as a condition of employment. Doctors typically provide a card indicating that a patient has undergone a tubal ligation, said those interviewed.

"I really see sterilization as an attempt to exterminate a problem, and that problem is poor people and in Brazil that means black people," Bispo said. "What's going to happen to black families if more and more women stop having babies? If you want to lift someone out of poverty what is better, educating them or sterilizing them?"

A physician by training, Trinidade, 43, estimated in an interview that he has arranged as many as 10,000 sterilizations. Neither race nor racism plays any role in his efforts, added Trinidade, who is white. Quite the opposite, he said. "Poor women prefer this method. It's simple. It's effective. Wealthy women have always had access to family planning. It's poor people -- black people -- who don't."

He said his approach has played an instrumental role in his political success, and that his efforts to decrease Brazil's birth rate precede his first electoral bid.

"It is a priority because we live in a country where the birth rate is higher than the gross domestic product," he said. "In other words, what grew was the misery. In some areas of Brazil, you will find women with up to 20 children.

"It's simple math: A woman can provide more easily for one child than two. Lowering the birth rate gives us an opportunity to increase per capita income."

Few women, he said, regret their decision to be sterilized.

But Santos has been reconsidering. A widow, she said that she is thinking about remarrying and has discussed having a second child with her boyfriend.

"But I can't now," she said. "I do regret it a little bit."

Rosangela de Jesus Santos, who had her sterilization arranged by Trinidade two years ago, said she has never regretted her decision. At 33, she has a 16-year old son, a fourth-grade education and a live-in boyfriend. Neither has a job.

"There is a problem with women having more children than they can take care of," she said. She is unable to provide for her son, so he lives with her parents. She searches for work every day, she said.

"What I really need is a job," she said. "I go from one place to another all day long but no one here is hiring. That's my number one problem."

She recalled Trinidade visiting the clinic waiting room and handing out campaign literature on the day she had her sterilization. Most of her friends who had their surgeries arranged by Trinidade voted for him, she said. She did not.

Voting is legally mandated in Brazil. Liliane Tavares, 24, a medical technician, said there are two things she is certain she will never do: get sterilized and vote for Trinidade.

Trinidade arranged for her mother's sterilization during his first campaign for city council more than 13 years ago in the days following the birth of Tavares's younger brother, the family's fourth child.

Her mother later regretted becoming infertile, Tavares said. "She told me that she really wanted to have six children," Tavares said.

Tavares, who thinks there is a misguided political focus on the birth rate in Brazil, said she was applying to medical school and hopes to become a gynecologist.

"I want to provide real health care to black women," she said. "I want to provide them with more options, not less."

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