Women’s experiences of sterilisation in Brazil: negotiating reproductive discourses, institutional and intimate relationships, and contraceptive practices

Abstract

The dramatic drop of the fertility rate in Brazil, from 6.2 births per woman in 1960 to 2.5 in 1996, has been attributed to women’s increasing use of sterilisation. Despite the fact that sterilisation was illegal, Brazil had the second highest rate in the world in 1996, at 40.1%. Political concerns regarding the abuse of the operation led to the legalisation of sterilisation in 1997 to provide regulation of the procedures. Subsequently, rates of reversible contraception have increased, and sterilisation rates dropped to 21.4% by 2013. Sterilisation in Brazil is thus a useful case study to examine how changing socio-legal contexts can influence experiences or understandings of this contraceptive technology. This research is based on semi-structured interviews conducted in 2013 with 35 women from a variety of socio-economic and ethnic backgrounds in Rio de Janeiro. This thesis is informed by a sociological perspective on health technologies that takes account of the social context and of lay users’ views of their experiences. Several different domains of social life that have an influence on participants’ understandings of sterilisation are thus examined, including: wider reproductive discourses, family and intimate relationships, the medical institution within which contraception is provided, and prior experiences of reversible contraceptive technologies. The thesis demonstrates the importance of examining sterilisation as a socially-mediated practice. At the institutional level, my analysis illustrates how women navigate the shifting ambiguous socio-legal context, as well as the systemic barriers to healthcare, when accessing sterilisation. The influence of intersections of gender, race and class are highlighted in this process, and is evident in women’s experiences of family and intimate relationships. At the embodied and individual level, the significance of the design of contraceptive technologies is emphasised, as well as women’s prioritisation of their own emotional and physical wellbeing and sexual pleasure. Furthermore, the analysis highlights how reproductive discourses intersect with cultural notions of family ideals and everyday practices, to influence both decisions about and understandings of sterilisation. Overall, the thesis illustrates how sterilisation is a socially mediated practice that varies dependent on macro contexts of cultural reproductive discourses, as well as institutional, interactional and individual levels.