Matters of Life and Longing: Female Sterilisation in Northeast Brazil (review)

Brazil's diminished birth rate and women's increased control over reproduction represent major shifts in the country's social history. Anthropologist Dalsgaard has provided us with a clearer understanding of how and why these changes occurred.

Thus Matters of Life and Longing is about much more than female sterilisation. It is a complex, broadly painted portrait of the lives of poor women in a working-class suburb of Recife. Gathering data on 1,762 women in Camaragibe, Dalsgaard employs traditional demography to measure the extent and context of tubal ligations. She reveals that in 1996, 40.1 percent of formally and informally married women between 15 and 49 were sterilized. Significantly, 60 percent of the ligations took place before the women reached the age of 30, thus revealing the enormous social pressures women feel to stop having children. She confirms the well-known correlation between caesarian sections and ligations. But, following the lead of Nancy Scheper-Hughes' Death Without Weeping, Dalsgaard also practices "demography without numbers": the taking "into account the multifaceted existential, cultural, medical, moral and political dilemmas . . . which in life surround any demographic fact" (33). Through the method of story-telling, we learn in detail numerous aspects of the lives of the 28 women with whom Dalsgaard conducted in-depth interviews, ranging from the hopes and dreams that led them to seek sterilisation to the humiliation they suffer before the personnel in public hospitals who demand that their pubic hair be shaved before giving birth. Dalsgaard thus provides us with an intimate understanding of what it is like to be a woman in modern Brazil.

The portrait includes many other scenes. Dalsgaard begins with a startling drawing (10) of the process of tubal ligation, commonly known as ligação. She proceeds with a Prologue in which she discusses motherhood in the context of the brutal, often drug-driven violence of the Recife metropolitan region. The theme of poverty permeates the work, with the author describing the neighborhood in which she conducted her field-work and giving voice to the women's plans to improve their socioeconomic status. Larger societal trends also come into view, for example, the medicalization of birth and women's health in the Brazilian northeast over the past four decades, the concomitant imposition of medical authority in women's lives, the laissez-faire attitude of the Brazilian state with respect to birth control (and the resultant lack of public contraceptive services, opening the way to millions of illegal sterilisations), and the dramatic drop in family size from six to three children per mother between the 1960s and the 1990s. Dalsgaard pays detailed attention to cultural factors impinging on the demand for sterilisation, namely the family structure, patriarchalism and males' tendency to shirk paternal responsibility, and changing notions of marriage, spousal relations, and motherhood.

She contrasts the utility of ligação with that of the relatively unreliable contraceptive pills and intrauterine devices, neither of which was the "right solution; they both represented too much of the uncertainty, fluidity and movement that people were striving to leave behind" (167). A ligação virtually ensured protection against pregnancy. Some women have even demanded to take home the removed pieces of their tubes as a guarantee against further worry.

Dalsgaard's central point is that women have taken the regulation of fertility into their own hands. Sterilisation has become "part of public discourse and was perceived as a natural aspiration for any woman" (108). Sterilisation, she asserts, is not simply a method of birth control but "a hope of control in one's own life" (27). "The women I met knew what they wanted. . . . Sterilisation was an attempt to create such conditions in their lives" (31). Her critique focuses not on the women themselves nor on sterilisation as a method of birth control, "but towards the conditions in which the women have to act" (207).

Ultimately sterilisation provides impoverished women the means to fulfill...