Brazil
Consequences of Tubal Ligation for Women's Lives
Tubal ligation is extremely common in Brazil: 40 percent of women, ages 15 to 49, who are married or in union, have been sterilized. The prevalence of sterilization is due, in part, to limited access to other contraceptive methods. The pattern of family planning use in Brazil is that women typically rely on oral contraceptives until they attain their desired family size, then elect sterilization. Fifty-seven percent of sterilized women undergo the procedure before their thirtieth birthday, and 34 percent of sterilized women have one or two children. Health workers, women's advocates and others have expressed concerns that, with so few contraceptive options, women may later regret their decision to end childbearing.
Research Findings
The Centro de Pesquisas das Doenças Materno-Infantis (CEMICAMP) in Campinas surveyed women to determine the impact of tubal ligation on their quality of life. Of the 472 study participants, half had been sterilized, while the other half had not. Study participants in the two groups were matched on age and residential neighborhood. Their ages ranged from 30 to 49 years, and women lived in low- to middle-income neighborhoods in Campinas. CEMICAMP interviewers administered questionnaires from December 1996 to June 1997 to explore women's perceptions of their quality of life, including their sense of well-being, self-esteem, marital satisfaction, and balance of power in relationships. Research findings include the following:
- Women who used tubal ligation as their family planning method were generally happy with their choice. Ninety-two percent of women who had undergone sterilization said they were satisfied with their method. Their reasons included: they had attained the number of children they wanted, the method was effective, and it was safe. Sterilized women were happier with their contraceptive choice than were women using other family planning methods. Non-sterilized women reported a 79 percent satisfaction rate. Among the reasons given for satisfaction were that they believed their own family planning method was safe, it was effective and it helped them achieve their ideal family size.
- Regret and dissatisfaction with sterilization were highest among women who were sterilized when they were young. Fifteen percent of women who were sterilized before age 25 said they were dissatisfied with their contraceptive method, compared with 9 percent who were sterilized at age 25 or older. Eighteen percent of women sterilized before age 25 said they regretted their decision, as did 7 percent of those ages 25 to 29.
- Among the sterilized women, the most frequently reported physical change was related to menstruation, with 36 percent reporting negative changes in their menstrual cycle and 11 percent reporting improvements. Fewer non-sterilized women attributed menstrual changes to contraceptive use; 12 percent said their method caused negative changes in their menstrual cycle, and 16 percent reported improvements.
- Twenty-one percent of sterilized women reported changes in their sexual life following the procedure. Fourteen percent said their sex lives had improved while 7 percent said their sex lives had gotten worse. Fifteen percent of non-sterilized women attributed changes in their sex lives to family planning methods. Half reported improvements and half, negative consequences.
- Small percentages (12 percent or fewer) of women in both groups reported improvements in their marital relationships, economic situations and self-esteem. Only 1 to 4 percent reported negative changes in these three areas.
- Of the 236 non-sterilized study participants, 101 women said they had considered having a tubal ligation. Their reasons for foregoing sterilization were: they could not afford the procedure; health service providers refused to perform the surgery because the woman was too young or had too few children; the woman feared surgery; or, her partner objected.
Recommendations
Women who used tubal ligation as their family planning method were generally happy with their choice. However, a woman's satisfaction with tubal ligation is often related to her age at the time of the procedure. Service providers and counselors should stress the potential for regret among women age 30 and under and discuss the risk factors for regret, including young age and marital instability. Given recent policy changes (sterilization has been legalized and guidelines established for sterilization candidates), the public sector faces a tremendous challenge to meet the counseling needs of what is likely to be an increase in demand. Access to a wider array of contraceptives, including long-term methods such as the intrauterine device, should be made available to meet the range of family planning needs for women over their life cycle.
Study Details
Ms. Maria José Duarte Osis, Ms. Maria Helena de Sousa, Dr. Aníbal Faúndes of CEMICAMP and Dr. Patricia Bailey and previously, Dr. Arlene McKay, of Family Health International were responsible for this study. Research was supported by the Women's Studies Project at Family Health International, through a Cooperative Agreement funded by the U.S. Agency for International Development. This study was funded by field support from the U.S.AID Mission in Brasília.
