ODUCTION
The Brazilian Total Fertility Rate (TFR) fell from 6.3 in 1980 to 2.5 in 1996. In its
poorest region, the Northeast, the TFR fell from 7.4 to 3.1 in the same period (BEMFAM/DHS
1997; Carvalho and Wong 1996). Data from the 1996 Demographic and Health Survey (DHS)
indicate that 40 percent of married Brazilian women aged 15-49 years were sterilized. In the
Northeast, this figure reached 44 percent. While in the other regions the bulk of sterilizations
were paid for by the women, politicians and doctors arranged and paid for 70 percent of the tubal
ligations in the Northeast.1 I argue that this phenomenon is the result of the association of an
increasing demand for contraception with the absence of effective public policies and thus poor
birth control options, the influence of doctors amidst the diffusion of a hospital-based curative
medicine, and the pervasiveness of a political behavior in which politicians provide goods and
services to the poor in exchange for votes. In this light, I analyze the provision of sterilization
among low-income women in the Northeast focusing on the determinants of its diffusion, its
clientelistic character, and the role of doctors.