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  • Title: Evaluation removes obstacles to sterilization in Brazil.
    Journal: Netw Res Triangle Park N C; 1985; 5(1):6-7. PubMed ID: 12314001.
    Abstract:
    In 1978, Centro de Pesquisas de Assitencia Integrada a Mulher e a Crianca (CPAIMC) in Rio de Janeiro began to offer interval sterilizations in an attempt to increase the access of poor women to sterilization services. By the end of 1984, the program had provided in excess of 19,000 sterilizations, making CPAIMC Brazil's largest single source of voluntary interval sterilization. Despite the program's success, CPAIMC was concerned that obstacles still existed in the poor woman's path to sterilization access. A study was conducted by Family Health International (FHI) in collaboration with the Pathfinder Fund and CPAIMC's Department of Information, Evaluation and Research to locate possible barriers. The study indicated that less than half of the women who requested sterilization between June 1 and August 31, 1983 actually had the procedure. During that period, 1256 women requested sterilization at the CPAIMC clinic. Of these, 925 were approved, and 639 were scheduled for surgery. Only 559 were actually sterilized within 3 months of receiving approval. 1 possible reason why women were not receiving the surgery was that the women requesting sterilization actually were not highly motivated to obtain the service. Yet, study results indicate this probably was not the reason. During initial interviews at the clinic, many women said they had thought very carefully about being sterilized, and more than 40% reported deciding to have a tubal ligation before their last pregnancy. Almost 3/4 of the women reported that they did not plan their last pregnancy, and almost 2/3 indicated that the pregnancy was unwanted. About 63% were contracepting, and many were using effective methods. More than half of the non-contraceptors were not using a method because they had just ended a pregnancy and were not sexually active. As a group, the women requesting sterilization were highly motivated to avoid having more children. Age and number of children were the most important criteria used by the clinic to determine a woman's eligibility for sterilization. Women who were at least 30 years old and who had 3 or more living children usually were approved for surgery. During the study period, a woman who did not use oral contraceptives, an IUD, or injectables was required to receive a Depo-Provera injection on the 5th to 8th day of her menstrual cycle before surgery was scheduled. This requirement was aimed at reducing the incidence of pregnancies among sterilized women. The number of clinic visits necessary to complete the requirements for sterilization apparently made the difference. Women who needed the Depo-Provera injection had to make more visits and were less likely to follow through to obtain the sterilization. As a result of the CPAIMC study, the clinic has changes its procedure for scheduling sterilization surgery. It is likely that even relatively small changes in service provision may yield significant increases in family planning prevalence and thus increase the coverage and quality of health care in Brazil.
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