Larissa RibeiroA period of about 35 years separates the first movements by certain sectors of Brazilian society in favor of policies related to regulation of fertility and the present day, when these demands have taken shape, at least in part, in the form of laws and services offered by the public health networks. “There has been a remarkable advance in these almost four decades,” says psychologist Margareth Arilha, a researcher at the Population Studies Center (NEPO) of the University of Campinas (Unicamp). The first demand to be met, according to anthropologist Andrea Moraes Alves, a professor at the Social Services School of the Federal University of Rio de Janeiro (UFRJ), was the launching of the Women’s Integral Health Care Program (PAISM), in 1983.
One important milestone of the period was the Joint Congressional Investigation Commission (CPMI) which was convened in Congress in 1992 and adjourned in 1993. Its purpose was to investigate accusations of mass sterilization of women in Brazil that had allegedly been carried out by, among other institutions, the Center for Studies on Integrated Assistance to Women and Children (CPAIMC), a private entity in Rio de Janeiro. The investigation was inconclusive in regard to these accusations, but it marked a historical turning point that influenced the drafting of the Family Planning Act (1996), according to Alves.
“The accusations against the CPAIMC, made chiefly by lawmakers, feminist entities and specialists in fields of health care and population studies, helped promote the concept of reproductive rights for women, rights that were then being discussed in society, but not yet legally established,” says the researcher, who analyzed the CPMI’s work in her study “The history of the CPAIMC: The introduction of female sterilization in Brazil.” In addition to accompanying the legislative sessions and observing their context, the study also followed the career of the Center’s founder and director, physician Helio Aguinaga, who was interviewed by Alves in 2013 at the age of 97. He passed away two years later.
The CPAIMC was formed in 1974 by a group of physicians, nurses and social workers from the São Francisco de Assis Hospital in Rio de Janeiro, and registered the following year as a “non-profit civic organization.” At first, the funding came from the United Nations Population Fund and then from the United States Agency for International Development (USAID) and various international organizations, principally from the United States. At the time, the driving force behind the massive international debate on birth control was concern over the so-called “population bomb” – the idea, based on statistical projections, that the growth in the number of inhabitants on the planet would exceed the world’s capacity to grow enough food to feed them all.
In Brazil, the predominant thinking among the ranks of the military regime was divided between those who embraced that concern and those who considered the high local fertility rates to be helpful in ensuring the settlement of the country’s entire territory. In the organizations that represented the medical community serving at private institutions, according to Alves, there was a strong tendency to favor the perspective of public health, based on the argument that birth control would contribute to the well-being of the population, principally for women, who should only have children when they wanted them. The Catholic Church, then more influential than it is today argued that it is the responsibility of couples to regulate fertility using “natural” means, to avoid having children they were unable to support, but opposed any artificial contraception method as contrary to nature.
According to Alves, the principal motivation for the strong foreign presence, widely decried in the CPMI as “external interference,” was the interest in defusing the “population bomb” where it seemed to be more dangerous – the developing countries (in Europe, fertility rates were falling). There was also a fear during the Cold War era that an increase in the numbers of destitute people would mean additional support for communist-oriented insurgencies. The stated objective of donations from international organizations was humanitarian: to promote birth control to improve the quality of life among the population. One objective piece of information helped change the focus of the discussion: the abrupt drop in the fertility rate in Brazil, which fell from 5.8 children per woman in 1970, to 4.4 in 1980, and 2.9, in 1990. Nevertheless, sterilization practices continued.
“With the expansion of CPAIMC activities in the favelas of the city of Rio de Janeiro, accusations began to be made about activities conducted at community health clinics,” says Alves. The Center’s work was based on agreements with municipal governments and the creation of autonomous hubs in impoverished communities. In 1984, the newspaper O Globo reported on the closing of a unit of the CPAIMC that was operating inside a school in the district of Acari, due to the incompatibility between the medical and educational activities. A low-income resident of this neighborhood said she had been coerced to undergo surgical sterilization. At the time, Aguinaga declared to the newspaper: “What we want is to bring improvements to these people who are living very poorly, in sub-human conditions.” In 1986, the Ministry of Health suspended tests of the contraceptive Norplant that were being conducted by the Center on poor women.
During the debates on the drafting of the 1988 Constitution, Aguinaga led a personal campaign to ensure that family planning would be included in the constitutional text. The public arguments presented by this physician, who continued to link the matter to economic development in Brazil, began to be openly contested by those who favored the individual perspective on reproductive rights. This was the unanimous orientation of feminist organizations, which obtained a victory with the approval of the text of Article 226 of the new Constitution, according to which family planning is “a matter on which the couple may freely decide” and that “any form of coercion by official or private institutions is prohibited.” Three years later, the Legislative Assembly of the state of Rio de Janeiro convened a CPI on female sterilization in the state, and Aguinaga was invited to testify. Also in 1991, isolated and without financial support, the CPAIMC closed its doors.
Omission by the state
During the congressional investigations, a suspicion was raised that CPAIMC activities had been guided by eugenic proposals, given the evidence that the “mass sterilization” was mainly focused on black women. In its final report, the state CPI recommended the opening of a congressional investigation on the federal level, as requested by federal congresswoman Benedita da Silva and by Senator Eduardo Suplicy, both representing the Workers Party (PT). Benedita da Silva, identified with feminism and the black rights movement, assumed the presidency of the joint commission. Disputes surrounding the statistical methodology that was used to calculate the percentage of black women among those sterilized meant that the accusations of eugenics remained inconclusive. The final CPMI report found a high rate (44%) of surgical sterilizations “to the detriment of less-invasive contraceptive alternatives” and found “omission by the Brazilian government” due to its failure to investigate private birth control initiatives.
Margareth Arilha, who was present for some of the crucial stages of changes in perspectives, such as the 1994 International Conference on Population and Development, held in Cairo, places the origins of the construction of the concept of family planning as an individual right in the growth of the feminist movements in Brazil at the end of the 1970s, a period of continuation of the military dictatorship. “Many feminists returned from exile bringing with them a debate centered on the maxim ‘our bodies, ourselves,’” says Arilha. Another important milestone, according to this researcher, was the creation of the Council on the Status of Women in São Paulo, during the administration of André Franco Montoro, the first governor elected by direct vote, in 1982, since the start of the military regime.
Two international conferences on population are singled out as historical moments by Cristiane da Silva Cabral, on the faculty of the Department of Maternal-Childhood Health of the School of Public Health of the University of São Paulo (USP) and a collaborator of NEPO. “The Bucharest World Population Conference, held in 1974, concluded that the best contraceptive is economic development, and the Cairo conference, in 1994, defined reproduction as a fundamental human right,” she says.
The 1988 Constitution and the 1996 Family Planning Act were consolidations of these initiatives. In order to ensure passage of the law, negotiations had to be held with the more conservative members of Congress and elements of society that led to restrictions on access to surgical sterilization, including the requirement that the woman be over the age of 25 or already have two children, and obtain authorization from her spouse. “Even so, this law is satisfactory, since it guarantees broad legal access to contraceptive methods,” affirms Cabral.
ALVES, A. M. The history of the Center for Studies on Integrated Assistance to Women and Children (1975-1992). Século XXI, Revista de Ciências Sociais. V. 4, pp. 180-216. July/December. 2014.