![Sample our Social Sciences journals, sign in here to start your FREE access for 14 days]({"type":"image" , "src" : "/sda/110822/TOC-Subject-Sample-2021-Social-Sciences.jpg"})
Abstract
This paper examines family planning in Brazil as biopolitics and explores how the democratization of the State and of reproductive health services after two decades of military dictatorship (1964–1984) has influenced health professionals’ and family planning users’ discourses and practices. Do health professionals envisage family planning as a ‘right’ or do they conceive it, following the old neo-Malthusian rationale, as a ‘moral duty’ of poor people, whose ‘irrational’ reproduction jeopardizes the family's and the nation's well being? And how do their patients conceptualize and embody family planning? To answer these questions, this paper draws on 13 months of multi-sited ethnographic research undertaken between 2003 and 2005 in two public family planning services in Salvador da Bahia, where participant observation was undertaken and unstructured interviews were conducted with 11 health professionals and 70 family planning users, mostly low income black women. The paper examines how different bio-political rationalities operate in these services and argues that the old neo-Malthusian rationale and the current, dominant discourse on reproductive rights, gender equality and citizenship coexist. The coalescence of different biopolitical rationalities leads to the double stigmatization of family planning users as ‘victims’ of social and gender inequalities and as ‘irrational’ patients, ‘irresponsible’ mothers and ‘bad’ citizens if they do not embody the neo-Malthusian and biomedical rationales shaping medical practice. However, these women do not behave as ‘docile bodies’: they tactically use medical and non-medical contraceptives not only to be good mothers and citizens, but also to enhance themselves and to attain their own goals.
Acknowledgements
The author is grateful to Milena Marchesi, co-editor and co-organizer of the 2008 American Anthropological Association session on which this paper is based, for constructive feedback and discussions. The author also wishes to acknowledge the stimulating comments of the discussant for the paper, Dr Elizabeth Krause, and of two anonymous reviewers. Funding for the dissertation research on which this paper is based was made possible by a Refeb grant (Exchange Program between France and Brazil, financed by the French Embassy in Brazil). Ethical approval for this research was not required by the EHESS (Ecole des Hautes Etudes of Sciences Sociales) of Paris, France, where the author obtained her PhD. However, the research was authorized by the Directors of both clinics where it was undertaken, oral consent was obtained prior to each interview with health professionals and patients and anonymity was granted to all interviewees.
Conflict of interest: none.
Notes
1. All translations from Portuguese into English are by the author.
2. In the mid-1960s fertility rates started to decline in the wealthiest regions of Southern Brazil and among upper-middle classes. In the following decade they dropped in all regions and classes (see Bozon and Enoch Citation1999).
3. Despite being very close to the Catholic Church and strongly pro-natalist, the Military government assumed an ambiguous laissez-faire attitude towards family planning organizations. For the history of family planning in Brazil see Fonseca Sobrinho (Citation1993).
4. The author undertook her PhD ethnographic research during two periods of six months each in 2003–2004 and a final month in 2005 in two family planning services and in a peripheral neighbourhood in Salvador da Bahia. She engaged in participant observation two to three half-days a week at a clinic and a maternity-hospital and conducted unstructured interviews with 11 health professionals and 70 family planning users, mostly low-income black women. At ‘Gine-Salvador’ clinic 27 female patients, 10 male patients, five physicians, two auxiliary nurses and one social worker were interviewed.
5. ‘Black’ translates here both ‘preto’ (black) and ‘pardo’ (brown, mixed), two of the terms used in the Brazilian national census to define colour/race, along with branco (white), amarelo (yellow) and indigena (indigenous).
6. The name of the clinic is fictitious.
7. In the early 2000s, the administration of family planning services was being transferred from the State to local Councils and many public health centres were undergoing structural reforms, therefore family planning services were not regularly provided.
8. After two caesarean sections, any pregnancy and delivery presents higher risks, therefore sterilization can be medically justified. On the use and abuse of caesarean sections in Brazil see: Berquó (Citation1993).
9. On the scientific and political debate on women's sterilization and reproductive rights in Brazil see Berquó (Citation1999); Côrrea and Avila (Citation2003).
10. All personal names in this paper are fictitious.
11. Introduced at the end of the nineteenth century from Europe (France) into Brazil, Spiritualism is nowadays practised only by a minority of Brazilians – 1.3% in 2000. The spiritualist movement, however, is very concerned with education, science and charity and owns nurseries, health centres and hospitals, so many health professionals are affiliated to it. Most health professionals interviewed by the author declared themselves as non-practising catholic, while most female patients interviewed did not regularly frequent any Church or ‘terreiro’ (Afro-Brazilian religions' place of worship). Only a minority regularly frequented evangelical Churches. In 2000, most Brazilians declared themselves as catholic, but the Catholic Church lost followers in recent decades (from 89.2% in 1980 to 73.8% in 2000), while evangelical Churches multiplied their followers (from 6.6% in 1980 to 15.4% in 2000), and the rate of non-religious Brazilians increased from 1.6% in 1980 to 7.3% in 2000 (IBGE Citation2000).
12. Dr Fabio's colleagues defined themselves as ‘brancas’, white, while he defined himself as ‘pardo’, literally light brown. Most health professionals working at family planning centres were women.
13. Both auxiliary nurses defined themselves as ‘negras’, which can be translated as ‘black’ in British English. This term, which was denigratory in the past, was re-introduced by the Black Movement in the last decades to assert racial pride and black power.
14. The English term ‘black’ is used here to translate both morenas and pardas (‘brown’, ‘light brown’ or ‘mixed race’ in English) the two terms most female family planning users adopted to define their colour, and negras (‘black’) which was mainly used by the youngest ones.
15. Similar findings have been found by the Brazilian anthropologist Ondina Fachel Leal in southern Brazil (see Leal Citation1995).
16. On Coutinho's theories on hormones see Coutinho (Citation1996, 1988a) and Manica (Citation2009).
17. On the contraceptive use of salted water in Salvador da Bahia see Rabelo (Citation2001).
18. Reference is made here to the book by Betsy Hartmann (Citation1995), ‘Reproductive rights and wrongs: The global politics of population control’. See references.
19. No reliable data on sterilized women's and men's regret after sterilization were available at the clinic.
20. Similar arguments were used by the women interviewed by Dalsgaard in a poor neighbourhood of the northeastern capital of Recife (see Dalsgaard Citation2004).