Many anguished Brazilian women want to reverse procedure

By the early 1990s, Brazil’s fertility rate had nose-dived to 2.1 children per woman. But officials were jolted by a simultaneous rise in cesarean sections, which had become the nation’s most popular method of childbirth. By 1986, 44 percent of Brazilian births were performed by C-section. The connection between sterilization and C-sections soon became clear. Taking advantage of a legal loophole that permitted sterilization under exceptional circumstances, such as cesarean births, doctors and their patients routinely agreed to have the surgery performed immediately after C-sections. As the number of cesareans increased, so did the rate of birth-related deaths among mothers. Brazil’s maternal mortality rate peaked at 220 per 100,000 births during the early 1990s, with some cities reporting rates as high as 350 per 100,000 births. The maternal mortality rate in the United States is 8 deaths per 100,000 births, according to UNICEF. The sterilization crisis was especially acute in such places as Goiania, a city of 1.2 million and the capital of the state of Goias in central Brazil. By the 1990s, Goias had a 60 percent sterilization rate among women of child-bearing age, one of the highest in the country. Many women who were sterilized without knowing of other options ended up protecting themselves from pregnancy, but not from sexually transmitted diseases, such as HIV, the virus that causes AIDS. In recent years, the number of HIV cases in Brazil has stabilized, but in many states, cases among women-especially married women-has continued to rise. Goiania officials said that in 1988, there were 13 cases of HIV among men for every one among women. Today the numbers are equal.