Sterilization in the northeast of Brazil

Profile of Female Sterilization in Brazil

(1) Background: This study analyzes the profile of female sterilization in Brazil by age, parity, type of delivery, place of delivery, color/race, region of residence, years of schooling, marital status, number of unions, and desired number of children reported by women; (2) Methods: The descriptive analysis is based on the most recent Brazilian database on reproductive health: the 2006 Brazilian National Survey on Demography and Health of Women and Children (PNDS). This dataset has information on the history of pregnancies with live births from January 2001 to July 2007; (3) Results: The study suggests that (a) women with high levels of sterilization, high percentages of more than one pregnancy in the period, and larger parity than the desired number of children tend to have high parity, be black, brown, or indigenous, reside in the North or Northeast, have low levels of education, and have two or more unions; and (b) women with high levels of sterilization, low percentages of more than one pregnancy in the period, and lower parity than the desired number of children tend to have cesarean sections, give birth utilizing private health care obtained through a private insurance plan or direct out-of-pocket payment at private hospitals, and be married. (4) Conclusions: The 1997 family planning law could be altered in order to allow female sterilization in conjunction with childbirth, as a way to attend the demand of Brazilian women in public hospitals. Policies are necessary not only to regulate the public sector, but also to aim better services at private institutions. Female sterilization should be discussed in the context of fertility below the replacement level, as one of its associated factors.

Frustrated demand for postpartum female sterilization in Brazil

During the last three decades, Brazilians have relied almost exclusively on two contraceptive methods, the pill and female sterilization, with sterilization use increasing over time. Until a new law was passed in 1997, sterilization was virtually illegal and not covered by either public or private health insurance. It was, however, frequently provided in public and private hospitals in conjunction with a cesarean section. The new law regulating sterilization provided for reimbursement for interval sterilizations by public health insurance, but placed restrictions on availability intended to reduce the use of cesareans. These restrictions included the prohibition of postpartum sterilizations. This paper focuses on women's sterilization intentions during pregnancy and their experiences postpartum. In a prospective study of 1612 pregnant women carried out in four Brazilian cities, there was substantial demand for postpartum sterilization in both the private and public sectors among women who wanted no more children. However, public patients were much 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.

Associação entre prevalência de laqueadura tubária e características sócio-demográficas de mulheres e seus companheiros no Estado de São Paulo, Brasil

O Brasil tem uma alta prevalência de laqueadura tubária. Alguns setores da sociedade acreditam que essa alta prevalência estaria indicando um controle da natalidade dissimulado, que visa diminuir a fecundidade nas camadas mais pobres da população. O objetivo deste trabalho é contribuir para a compreensão das possíveis diferenças sócio-econômicas quanto à prática da laqueadura. Para este fim, analisamos uma base de dados com 1.335 mulheres com idade de 15 a 49 anos, obtida entre mulheres de nível sócio-econômico médio-baixo ou baixo, em duas regiões do Estado de São Paulo, no ano de 1991. Os resultados mostraram uma aparentemente maior prevalência de laqueadura entre as mulheres com menor nível educacional e também entre as que moravam em habitação de boa qualidade. Entretanto, ao controlar por idade, essas associações desapareceram, sugerindo que se deviam apenas a menor escolaridade e maiores recursos das mulheres de maior idade, sendo este último o fator mais fortemente associado à prevalência de laqueadura. Discute-se a complexidade das relações entre nível sócio-econômico e ligadura tubária, incluindo a diferença sócio-econômica na prevalência de cesárea, intimamente ligada à esterilização feminina.

A review of safety, efficacy, pros and cons, and issues of puerperal tubal sterilization--an update

This review focuses on the safety, efficacy, pros and cons of tubal sterilization procedures performed during the puerperium period while the woman is still in hospital. Findings from four previous reviews are synthesized, and the results published in more recent literature are evaluated. The review finds that tubal sterilization performed while the woman is still on the delivery table, or during a woman's early puerperium while she remains hospitalized, is operationally easy and medically safe, and does not adversely affect lactation. However, reported pregnancy rates are generally higher in puerperal tubal sterilization than in interval sterilization, especially when the mechanical tubal occlusion technique is used. The Pomeroy method, and its modifications via minilaparotomy, is highly recommendable. On the other hand, electrocoagulation via laparoscopy is associated with high efficacy, but a potentially increased risk of complications and difficulties in tubal reversal. Tubal sterilizations can be easily and safely performed at cesarean delivery in selected cases. Tubal sterilization performed during puerperium has a number of advantages over short-acting contraceptive methods, which require strict compliance, for postpartum use. However, candidates for puerperal tubal sterilization need to be carefully screened and counseled, since post-sterilization regret is more likely to occur. Unsettled issues for puerperal tubal sterilization and a number of practical problems that need to be addressed before initiation of a puerperal tubal sterilization program in a maternity clinic/hospital are discussed.

[Female sterilization among low income women in a metropolitan region of southeastern Brazil and factors related to its prevalence]

A survey carried out in the metropolitan region of S. Paulo between March and July, 1992, shows that of 3,149 low income women aged from 15 to 49, 21.8% had been sterilized. Of those women living in marital union 29.2% had been sterilized and 34.4% were on the pill. Four hundred and seven sterilized women under 40 years old who underwent sterilization at least one year before the interview were asked about their reproductive life, the previous use of contraception, the decision-making process regarding their sterilization, the access to the operation and their adaptation after the operation. The results show that access to sterilization is obtained by means of payment to the doctor even in the case of low income women. The lack of regulation of sterilization and the insufficient provision of family planning methods by the Women's Health Comprehensive Programme are probably encouraging young women to opt for sterilization. The provision of sterilization presents ethical problems. The study shows that the irreversibility of the procedure was not understood by almost 40% of the women sterilized. The acceptability of sterilization as a result of a complex social strategy involving various sectors of Brazilian society associated with the need for the control of fertility felt by women are discussed. The need to regulate and control the procedure is discussed. The regulation of sterilization would create fairer access to sterilization and could safeguard the ethical aspects of its choice.

Tubal ligation at cesarean delivery in five Asian centers: a comparison with tubal ligation soon after vaginal delivery

Increasingly more tubal sterilizations are being performed at the time of cesarean section in the United States and probably also in developing countries. This descriptive study provides us with hitherto unavailable information on the impact of this combined procedure on the women undergoing it. Five Asian centers were included for study. In these centers, 618 women had concurrent tubal ligation at cesarean section in 1973 and 1974. During this period, 3399 women had tubal ligation soon after term vaginal deliveries. The much higher morbidity and mortality in the former group were judged to be attributable to the indications leading to, or the complications of, cesarean section and not to the concurrent tubal ligation. Women undergoing the combined procedure of tubal ligation and cesarean section were more likely to have characteristics associated with later regretting the sterilization.