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The impact of health care providers on female sterilization among HIV-positive women in Brazil

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  • Hopkins, Kristine
  • Maria Barbosa, Regina
  • Riva Knauth, Daniela
  • Potter, Joseph E.

Abstract

This paper explores the reproductive preferences and outcomes of HIV-positive women in two cities in Brazil. We used three types of data, all drawn from women who delivered in public sector hospitals: (1) clinical records of 427 HIV-positive women; (2) pre- and postpartum in-depth interviews with 60 HIV-positive women; and (3) a prospective survey carried out among 363 women drawn from the general population. The HIV-positive samples were collected on women who had prenatal care between July 1999 and June 2000, and the general population survey was conducted with women who started prenatal care between April 1998 and June 1999. Among the women in the clinic sample, we found dramatic differences in the proportion sterilized postpartum: 51% in São Paulo vs. 4% in Porto Alegre, compared to 3.4% and 1.1%, respectively, of women in the general population. Our qualitative data suggest that HIV-positive women in this study had strong preferences to have no more future children and that female sterilization was the preferred way to achieve this end. Therefore, we conclude that the large difference in rates is mainly due to HIV-positive women's differential access to sterilization in the two settings. In-depth interviews revealed that women in São Paulo were often encouraged by clinic staff to be sterilized postpartum. In contrast, HIV-positive women in Porto Alegre clinics were not offered sterilization as an option and those who requested it were repeatedly put off. The striking difference found in the frequency with which doctors provide postpartum sterilization to seropositive women in our study sites deserves attention and discussion in the respective medical communities. At the higher level of national policy on reproductive rights, there may be grounds for reopening discussion about the norms regarding postpartum procedures, and for devoting far more resources to expanding contraceptive options.

Suggested Citation

  • Hopkins, Kristine & Maria Barbosa, Regina & Riva Knauth, Daniela & Potter, Joseph E., 2005. "The impact of health care providers on female sterilization among HIV-positive women in Brazil," Social Science & Medicine, Elsevier, vol. 61(3), pages 541-554, August.
  • Handle: RePEc:eee:socmed:v:61:y:2005:i:3:p:541-554
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    References listed on IDEAS

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    1. Allen, S. & Serufilira, A. & Gruber, V. & Kegeles, S. & Van de Perre, P. & Carael, M. & Coates, T.J., 1993. "Pregnancy and contraception use among urban Rwandan women after HIV testing and counseling," American Journal of Public Health, American Public Health Association, vol. 83(5), pages 705-710.
    2. André J. Caetano & Joseph E. Potter, 2004. "Politics and Female Sterilization in Northeast Brazil," Population and Development Review, The Population Council, Inc., vol. 30(1), pages 79-108, March.
    3. Hopkins, Kristine, 2000. "Are Brazilian women really choosing to deliver by cesarean?," Social Science & Medicine, Elsevier, vol. 51(5), pages 725-740, September.
    4. Bedimo, Ariane Lisann & Bessinger, Ruth & Kissinger, Patricia, 1998. "Reproductive choices among HIV-positive women," Social Science & Medicine, Elsevier, vol. 46(2), pages 171-179, January.
    5. Joseph E. Potter, 1999. "The Persistence of Outmoded Contraceptive Regimes: The Cases of Mexico and Brazil," Population and Development Review, The Population Council, Inc., vol. 25(4), pages 703-739, December.
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