Rapid economic changes and rising industrialization under the military regime in the 1960s transformed Brazil, shifting millions from rural to urban landscapes. While many benefited from growing wealth, many more were concentrated into impoverished urban neighborhoods and struggled with poor infrastructure, rising violence and crime, and lack of government services—conditions in which having many children was seen as an undesirable liability. At the same time, access to healthcare services expanded as roads were built connecting rural and urban areas. Family health services, including the provision of birth control options, expanded with health care, despite resistance from the Catholic Church. Nonetheless, the availability of multiple reliable methods of contraception has been remarkably low.
Tubal ligation, a surgical process in which women are rendered infertile, is the most popular form of birth control in Brazil, with between 25% and 40% of Brazilian women having undergone the procedure. Sterilization became increasingly popular after the 1970s, primarily among wealthy women who had access to private clinics, and was often performed after a cesarean section, but sterilization soon spread across classes. Brazilians debated its legality in the 1990s, and sterilization was ultimately legalized in 1997 under Fernando Henrique Cardoso and determined to be the right of any woman over age twenty-five with at least two children.
Women seek sterilization as a reliable means of birth control, basing their choice on family size, socioeconomic status, and problems in their marriages. Religious belief does not appear to have an outsized impact on women’s contraceptive choices; a 2014 poll indicated that over 90% of Catholic Brazilians reject the Church’s teachings on birth control. As a result of sterilization and use of hormonal birth control pills, Brazil’s fertility rate has plummeted, averaging 1.8 births per woman in 2012.
Though popular, sterilization is controversial. It is currently most popular in Brazil’s impoverished northeastern region, where it is heavily promoted among poor, predominantly black women. While women seek out tubal ligations, it has also been encouraged by physicians, some of whom stand to gain financially by performing the surgery, and by politicians. The connection between sterilization and politics is especially problematic; politicians offer free sterilizations in return for votes, election years tend to see greater numbers of sterilizations, and campaign posters at times make offers of sterilization. Politicians receive support from sterilized women, but can also make claims to be addressing poverty through population control. Perhaps the most vocal opponents of sterilization have been Afro‐Brazilian anti‐racism activists and feminist organizations, not religious organizations. These groups point to the prevalence of sterilization—including what they claim to be forced sterilizations—among poor black women, Brazil’s longstanding experience of racism, the unclear motivations of international agencies, and the lack of birth control alternatives and education to poor women. Anti‐poverty activists note that sterilization hasn’t effectively addressed women’s socioeconomic conditions; poor women stay poor. Instead, they consider sterilization a distraction from educational and employment programming.
 Cynthua Gorney, “Brazil's Girl Power,” National Geographic, September 2011, http://ngm.nationalgeographic.com/2011/09/girl-power/gorney-text, accessed July 8, 2014.
 Ernesto F. L. Amaral and Joseph E. Potter, “Determinants of female sterilization in Brazil, 2001–2007,” (2014), Rand Corporation.
 Anne Line Dalsgaard, Matters of Life and Longing: Female Sterilisation in Northeast Brazil (Gylling: Narayana Press, 2004), p. 28.
 Sam Frizell, “Poll: Catholic Beliefs at Odds With Vatican Doctrine,” TIME, February 9, 2014, http://time.com/6048/poll-catholic-beliefs-at-odds-with-vatican-doctrine, accessed July 8, 2014.
 “Fertility rate, total (births per woman),” The World Bank (2014), http://data.worldbank.org/indicator/SP.DYN.TFRT.IN, accessed July 8, 2014.
 Andre J. Caetano and Joseph E. Potter, “Politics and Female Sterilization in Northeast Brazil,” Population and Development Review, Vol. 30, No. 1 (2004); Jon Jeter, “Infertile Ground is Sown in Brazil,” The Washington Post, June 11, 2004, http://www.washingtonpost.com/wp-dyn/articles/A32622-2004Jun10.html, accessed July 8, 2014.
 Kia Lilly Caldwell, Negras in Brazil: Re‐envisioning Black Women, Citizenship, and the Politics of Identity (New Brunswick: Rutgers University Press, 2007), p. 156.
 Jeter, “Infertile Ground is Sown in Brazil,” The Washington Post.
"Brazilian women near the Community Center of Pirajá," World Bank Photo Collection (2012), Flickr Creative Commons.