I think that Brazilian youth are absolutely right in their reproductive choises:
Vasectomia e a laqueadura apresentaram um aumento significativo desde a diminuição da idade mínima por lei, mostram dados do Ministério da Saúde
oglobo.globo.com
I always knew I didn't want to be a mother', says 22-year-old woman who underwent tubal ligation; voluntary sterilization among younger people is on the rise in Brazil
Vasectomy and tubal ligation have seen a significant increase since the minimum age was lowered by law, data from the Ministry of Health shows
By
Rachel Pereira - Rio de Janeiro
07/17/2024 04h30 Updated2 months ago
Gabrielle Lotti, 22, chose to have her tubal ligation even though she doesn't have children Personal archive
The change in Brazilian law in September 2022, which allows voluntary sterilization from the age of 21, even without children, and no longer requires the consent of a spouse, has increased the demand for tubal ligation and vasectomy. Both procedures are part of what is called family planning, a right guaranteed to every citizen to define their reproductive future.
According to data from a survey conducted by the Ministry of Health, the number of women seeking by the contraceptive procedure jumped from 54,222 cases in the year the new law was enacted to 98,019 in 2023, an increase of 80.77%. The number of male seeking by the contraceptive procedure jumped from 67,689 to 95,209 in the same period, 40.63% more surgeries.
This has caught the attention of professionals in the field, as the choice for voluntary sterilization has been made mainly by young, childless people of both sexes.
Making access viable attracts young people
The decision to not have children through voluntary sterilization has several stages. When considering using the public system, the first step is to visit a basic health unit (UBS), where the patient is referred to a family planning clinic and then to the professionals responsible for monitoring the case.
Furthermore, it includes the signing of several documents and carrying out tests to confirm the absence of psychological disorders that put consciousness at risk or that determine that the person cannot receive anesthesia.
Previously, legislation 9.263/1996 stipulated that sterilization could only be performed from the age of 25, and that the express consent of the spouse was mandatory for both surgeries. However, sterilization was free to be performed at any age in the case of people with two living children.
For Yasmin Koury, 21, the change in the law came as a relief. She had considered waiting until she turned 25, but after reaching the new minimum age in August 2023, she was able to file the paperwork for a tubal ligation sooner than expected.
— I had the surgery on June 5, 2024, almost a year after I filed the request for tubal ligation. I feel relieved. Even though there is a chance of failure, the contraceptive chances are very high when you combine it with other methods, such as the IUD and condoms — says the archaeologist, a master's student at the Federal University of Pernambuco (UFPE).
Her post about the subject went viral on the social network X. In it, Yasmin shared a photo lying down right after the end of the procedure and quotes in the caption the well-known phrase by the writer Machado de Assis: “I didn't have children, I didn't pass on the legacy of our misery to any creature”.
— I always knew I didn't want to be a mother. As a child, I played with my friends and never wanted to be my doll's mother. I was a sister, a friend or a neighbor — says Yasmin, who underwent the procedure through her health insurance.
Gabrielle Lotti, 22, managed to undergo the procedure on April 10 this year, but had already sought out a health center in Palmeira das Missões, in the interior of Rio Grande do Sul, a year ago.
The new rules had a period of 180 days until they came into effect. Therefore, they only came into effect in the country on March 2, 2023.
— As soon as the protocol was sent, the health assistants at my local health center contacted me immediately and I started the documentation process. The surgery went extremely smoothly and the recovery has also been easy. I was afraid of the post-operative care, but in the end it was easier than I imagined — she says.
After successfully completing the procedure, the young woman began sharing her journey to sterilization through the Unified Health System (SUS) on the TikTok platform to help other women interested in doing the same.
— Since tubal ligation is still a taboo subject, there is not much information about it. This is probably because those who undergo the procedure are often the target of prejudice and insults. So I decided to share my experience to inform, clarify doubts and encourage those who have already made this decision but are still afraid and don't know where to start — she explains.
In the case of Matheus Duarte, 26, as soon as he entered adulthood, a vasectomy became a possibility, but he preferred to wait until he was older before starting to look for one.
This year, the administrative assistant made the decision not to have children and will continue with the process to have a vasectomy by the end of next year.
— I started to consider this choice because since I was a teenager I was always aware that I didn't want to have any children and today I still have this thought. I believe that the procedure would be the most efficient way to have a more structured plan for this — she ponders.
Reproductive autonomy
In this context, Jimena de Garay, professor of psychology at the State University of Rio de Janeiro (Uerj), notes that the change brought about by the new law guarantees a greater capacity for reproductive autonomy for the new generation.
— How women feel about motherhood, the fear of getting pregnant or creating a human being from scratch, are fears and concerns that have always existed. This applies to men as well. People now know that they can decide what to do with their own bodies. There is no longer that social obligation to be a mother to be a woman or to be a father to be a man as before. Furthermore, only now is medical technology being able to contemplate this decision not to procreate — highlights the researcher in the area of sexual and reproductive rights.
Another element is the growing concern about the future, according to the psychologist.
— The world seems to be “tighter”, more unequal, with more difficulties in planning a future and finding a job, from the perspective of young people. That is why many choose not to have children — analyzes Garay.
According to gynecologist Ilza Maria Urbano Monteiro, a member of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) and who works for the Unified Health System (SUS), the queues for surgical intervention are getting longer in both public and private hospitals.
For the tubal ligation specialist, the high demand is due to a combination of factors. One of them is the scope of the power of choice, which, according to the new law, does not depend on the partner's approval. Another is the reduction of the minimum age to 21 years, increasing the scope of people.
— There is indeed an increase in demand among the younger population, not necessarily just in the 21 to 25 age group. I believe that the possibility of performing tubal ligation during a cesarean section or after childbirth has also facilitated access — he states.
From the same point of view, gynecologist and obstetrician Karina Tafner, from Hospital Santa Casa de São Paulo, notes that reversibility can bring greater safety to women who opt for ligation. However, just like men interested in having a vasectomy, they need to go through the required 60 days of reflection (between the active search and the actual procedure).
— But even so, the success rates for reversal are not high, they vary between 40% and 80%. This needs to be taken into consideration. It is considered a complex procedure, which is why, by law, there are 60 days of reflection after all the guidelines — emphasizes Tafner.
On the other hand, a point of concern raised by Monteiro is the decision to undergo tubal ligation without trying other contraceptive methods considered safe and easier to reverse.
— We have methods that are just as effective as tubal ligation that are available to women in the public system. IUDs and implants are also very effective — he notes.
Another issue is that the topic is still being discussed in the legal sphere. However, with the intention of making it possible for young people to make the decision even earlier. Deputies from the Brazilian Socialist Party (PSB) presented to the Supreme Federal Court (STF) a proposal for the minimum age to be 18 years old, considered the entry into legal adulthood in the country.
— From what I have observed, if the deputies' project to request the STF to lower the minimum age even further goes ahead, the rate of regret regarding tubal ligation, which already exists and is high, will only increase — the gynecologist at Febrasgo highlights.
Urologist Henrique Machado, who specializes in minimally invasive surgeries at the State University of Rio de Janeiro (UERJ), believes that, in the case of vasectomy, the increase observed in the data is due to the spread of reversal surgery among men and the change in perception regarding stigmas.
— There has been a change in men's understanding of the procedure. Now they know that it is relatively simple and that the surgery does not affect libido or erection, a common fear among men. Vasectomy reversal, although not 100% guaranteed, is especially appealing to younger men without children — the doctor ponders.
How the two methods work
The purpose of tubal ligation is to block the fallopian tubes, which connect the uterus to the ovary, to prevent sperm from reaching the eggs. This can be done by cutting, tying or inserting a ring in them, in a medical procedure that takes around 20 to 30 minutes in a laparoscopy (called a vaginal procedure, performed through small incisions with the aid of a device called a laparoscope), or up to 60 minutes in a laparotomy (called an abdominal procedure, with the opening of a small part of the abdomen).
Vasectomy refers to the removal of a fragment of the two tubes that carry sperm from the testicles to the penis. In this procedure, anesthesia is applied to the scrotum. It lasts about 30 minutes and the stitches usually heal within a week.
Up to three months after surgery, the use of other combined contraceptive methods is recommended, as there is still a risk of pregnancy.
For disrespectful behavior towards those seeking the service to perform the procedure or actions in the SUS against the established law, complaints can be made through Disque Saúde (136) or to the official ombudsman's office at the address:
https://www.gov.br/saude/pt-br/canais-de-atendimento/ouvsus.
Also South Korean Women are right:
South Korea has spent billions to reverse its low birth rate, but some say it isn't listening to young women’s needs.
www.bbc.co.uk