Family planning makes searches for tubal ligation increase – 04/16/2024 – Balance and Health

The search for long-term methods to reduce the number of children, avoid or delay the first pregnancy has grown recently.

This behavior shows how couples and, above all, women, are aware of the need for family planning for their own survival and quality of life.

The increase is linked to changes made to the Reproductive Rights Law (law no. 9263/96) in the years 2022 and 2024, allowing anyone aged 21 (regardless of the number of children) or at least two children to request the surgical procedure (vasectomy for men and tubal ligation for women), as long as a minimum period of 60 days is respected between the request and the surgery.

Experts say that the simplification of criteria for access to contraceptives (from the contraceptive pill to sterilization) has enabled young women to have greater access to the methods in the country.

This was not, however, the case with traffic manager Bianca Veiga, 27 years old and resident of Diadema, in the Greater São Paulo region. She sought a tubal ligation from 2020 to 2021 and ended up getting pregnant while waiting for a safer contraceptive method through the SUS (Unified Health System) — the denial was due to her age (she was 24 years old at the time) — and spent nine months waiting for an IUD ( intra uterine device).

“I’m married and I chose to do family planning because I didn’t have that dream. I love my daughter more than anything, but I couldn’t imagine being a mother. It happened and now she’s going to be 3 years old”, she says. To this day, she is awaiting authorization from a professional at the UBS (Basic Health Unit) for the procedure.

With the change in the law, however, more women were able to seek out the methods — and thus have greater control over when and how they want to become mothers.

In addition to the 60-day period, the applicant must undergo counseling from a multidisciplinary health team, “with a view to discouraging early sterilization” but, if desired, there is nothing in the legislation that prevents the procedure from being carried out, says the law .

According to the SES (Secretariat of State for Health) of São Paulo, the number of tubal ligations performed by the SUS jumped from 22,392, in 2022, to 39,276, in 2023 — an increase of 75.4%. IUD insertion also grew, from 41,118 to 43,255 procedures in the same period (an increase of 5.2%).

The folder also informs that, in just the first two months of the year, another 7,137 tubal ligations and 6,256 IUD insertions were performed — equivalent to 18.17% and 14.46%, respectively, of the procedures carried out in 2023.

In the city of São Paulo, according to the SMS (Municipal Health Department), until March this year, 418 IUD insertions and 2,353 tubal ligation procedures were carried out.

Veiga says that, during prenatal care and in all consultations (carried out with two different doctors), she requested a tubal ligation during birth, but was informed that this would only be possible if she had a cesarean section. In 2024, with the change in the law, this no longer became necessary, with the condition for surgical sterilization during childbirth being only a minimum prior request of 60 days and that there are “due medical conditions”.

“If I had a natural birth, they said I could have the IUD inserted at that moment. I took the request to the hospital and they said it wouldn’t be possible right away because I got an infection,” he says.

Just six months after the birth of her daughter — and many trips to the UBS —, the manager managed to insert a hormonal implant that a nurse recommended as a “better than an IUD” method.

In response, the SMS says that the manager’s data was found at UBS Jardim Lourdes only from the first prenatal consultation and that “there is no record of a request for the user’s voluntary sterilization process”.

There would also be no record of the patient’s intention to use the IUD, who “had the baby in June 2021 and, in November of the same year, opted for the subdermal implant [comercializado pelo nome Implanon]”.

Regarding the denial of tubal ligation, the advisory says that “at the time of the request, the law stipulated a minimum age of 25 years or at least two living children, a topic that would only be changed on September 2, 2022, by Federal Law No. 14,443”.

Now, the ministry says it is following the current rule, with tubal ligation permitted from “21 years of age, regardless of the number of living children”, not even being “the consent of spouses necessary for it to be carried out, as well as a history of cesarean sections “. Tubal ligation in natural birth, in turn, was authorized on March 22, 2024, through ordinance No. 1,549 of the Ministry of Health.

The two procedures, according to the municipal ministry, increased from 2022 to 2023, from 10,255 to 12,415 (both tubal ligations and IUD insertions).

For gynecologist Consuelo Callizo Genes, medical director of the Elsimar Coutinho Medical Center and Clinics, which provides free care on reproductive issues through the SUS, family planning improves the population’s living conditions, reducing poverty.

She considers that the number of children not only impacts the family’s expenses, but also its productive and financial capacity, especially for women.

“If I want to have ten children, I have ten children; but if I don’t want to, I have to have that right to choose,” says Genes. Patients’ financial conditions should not limit their access to contraceptives, explains the gynecologist.

“Tubular ligation and vasectomy are the end of the line, because, if there is regret, it is very difficult to reverse these techniques. In addition to being extremely expensive, they are difficult to perform”, he highlights.

Regarding the delay in the SUS to obtain a tubal ligation, the doctor says that there is a waiting list and that mothers with more children tend to have priority, and even the lack of access to pre-operative exams, such as a simple electrocardiogram, makes it difficult the process.

Lawyer and writer Marcelo Valio, professor at Centro Universitário Social da Bahia (Unisba) who works with the rights of vulnerable people, says that the infringement of reproductive rights implies the exclusion of decision-making power, especially of women.

“If there is no possibility of success with this body, they can seek to report it to the Public Prosecutor’s Office and seek the Public Defender’s Office or through a private lawyer”, says the professor, also indicating to seek social assistance in each city.

In cases of excessive delay in availability or medication failure, whether provided by the SUS or through an agreement, there is the possibility of requesting compensation in court to contribute to the support of the unplanned child. However, it is necessary to prove that there was a disproportionate wait.

“The organs [responsáveis] have an obligation to make these resources available and should not place barriers to the exercise of these legal reproductive rights”, explains the lawyer.

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