BRAZIL: Controversial Bill to Sterilise Younger Women
By Fabiana Frayssinet
RIO DE JANEIRO, Aug 22 (IPS) - A draft law to reduce the minimum age for women to undergo voluntary sterilisation in Brazil’s public hospitals from 25 to 18 is vigorously opposed by the government.
A Brazilian Republican Party senator and bishop of an evangelical sect, the Igreja Universal do Reino de Deus (Universal Church of the Kingdom of God), Marcelo Crivella, who introduced the draft law in the Senate, said it would help reduce violence, because "children who would be hungry and abandoned wouldn’t be born" -- factors that he argues are related to crime.
The current law regulating family planning states that voluntary sterilisation is only permitted for men and women who are over 25 years of age and have at least two living children.
The Health Ministry is against the draft law. Several family planning options are available in the public health services, including sterilisation of women by tying off the Fallopian tubes, an operation which prevents eggs from reaching the uterus from the ovaries, thus preventing fertilisation.
In an interview for the government broadcaster Agência Brasil, Health Minister José Gomes said he was "radically against" reducing the age for voluntary sterilisation, "because that’s not family planning, it’s fertility control," a phase he considers to be a thing of the past in this country of over 188 million people.
Regina Viola, coordinator of the Technical Area of Women’s Health at the Health Ministry, told IPS that tubal ligation "is considered to be an irreversible contraceptive method, since if a woman later changes her mind, the surgery cannot always be reversed."
Studies by the ministry indicate that "between two and 13 percent of women change their minds, depending on their age and the circumstances surrounding the tubal ligation. Among women under 30 at the time of the operation, most change their minds," she said.
Elizabeth Ferraz, coordinator of the research department of the non-governmental organisation BEMFAM, told IPS that the latest study of national demographic and health data, carried out in 1996, showed that 77 percent of women who were married or in a stable relationship used some method of contraception, and 40 percent of them had been sterilised between the ages of 15 and 49.
The study was undertaken by BEMFAM, which works on sexual and reproductive health issues in 13 Brazilian states.
The average age of the women at the time they were sterilised was 28.9 years, but 20 percent of them were under 25. Thirty-seven percent were aged 25 to 29, 28 percent were aged 30 to 34, 12 percent were aged 35 to 39, and three percent were aged 40 to 44.
According to Ferraz, the contraceptive methods used vary according to the women’s age and circumstances. For instance, many women at the height of their fertility use contraceptive pills to space their births, and when they consider they have the ideal number of children, they choose to be sterilised.
Furthermore, the more education a woman has, the wider the variety of family planning methods used, and the more frequently their partners have had a vasectomy (male sterilisation), the expert said.
While Ferraz considers sterilisation of women to be neither good nor bad in itself, but simply another choice available to women, she is concerned about the proposal to reduce the minimum age.
"This proposal is rather radical. We could do more through public policies, like giving the public more information about the variety of methods, and spend money on awareness-raising campaigns so that women can exercise birth control without resorting to a drastic measure like getting their tubes tied at the beginning of their sexual life. Different methods are suited to different stages in life," she said.
Ferraz pointed out that sterilised women often change their minds when they begin a new relationship, or if one of their children dies.
In the poorest areas of the country, indices of female sterilisation are higher than the national average: 43.9 percent in the northwest, and 59.5 percent in the centre-west. "Sometimes, access to other methods is difficult, and in the absence of other options, women opt for sterilisation," Ferraz pointed out.
In the context of poor populations with limited access to healthcare and education, "sterilisation is often a vote-catcher," said Ferraz. In doubt as to the effectiveness of other methods, such as condoms, pills or intrauterine devices, many women who have little money or education choose to be sterilised, thinking "they won’t have to worry any more."
A question which should be cleared up by a census on family planning that is being carried out by the Health Ministry is "to find out whether in Brazil, where the rate of caesarean deliveries is very high, caesarean sections encourage sterilisations, or whether sterilisation encourages caesareans," Ferraz said.
According to the 1996 study by BEMFAM, out of the total number of sterilised women, 59 percent had their tubes tied during a caesarean delivery, while only 15 percent had the sterilisation operation done after a normal birth.
The Health Ministry’s Viola also said she thought that information about the methods available, where to obtain them and how to use them, should undergird any reproductive health campaign.
The new National Policy on Family Planning, launched by the Health Ministry in late May, provides, among other actions, for a publicity campaign to offer clear information and stimulate family planning, and mass distribution of educational material about contraceptive methods to schools and community centres.
It also plans to expand the supply of contraceptives to basic health clinics from 20 million to 50 million blister packs of pills, and to encourage vasectomy operations in public hospitals. Brazil’s fertility rate began to decline in the late 1960s.
According to Ferraz, in 1960 the fertility rate stood at an average of six children per woman, but by 1996, the date of the last family planning census, it had fallen to 2.3 children per woman, and in some urban centres like Rio de Janeiro, it was even lower, at 1.9.
The expert cited economic reasons for the decline in fertility, such as migration from rural areas to the cities, and women’s entry into the labour market. Today, barely 20 percent of Brazilians live in rural areas, where there is less access to information. (END/2007)