Electoral cycles in female sterilization

Many women across the world face substantial challenges in obtaining access to family planning—an important problem emphasized by the Sustainable Development Goals. The present study explores electoral cycles in female sterilization, the most prevalent contraceptive method in the world. We focus on Brazil, a country where many women have unmet demands for sterilization and often queue for many months or even years for their surgeries. Qualitative evidence suggests that local politicians distort the provision of publicly funded tubal ligation surgeries for political purposes. We analyze the universe of tubal ligation surgeries performed by the public health system, using regression analysis to examine variation across Brazilian municipalities in 1998–2019. We find that female sterilizations increase 8.8% during municipal election years. Moreover, they surge during electoral campaigns: female sterilizations increase 30.5% in the three months before municipal elections. Findings are similar when adjusting for overall hospitalizations, which rise less than 1% during municipal elections. Female sterilizations have more pronounced electoral cycles than do other elective surgeries (including vasectomies), and no cycles are detected for emergency surgeries. Electoral cycles in female sterilization are concentrated among nonwhite Brazilians, who face substantial health disparities. Female sterilizations increase far more during municipal than national elections, and they spike especially in poor municipalities and in the Northeast region. More broadly, our findings suggest that Brazilian politicians distort the public provision of contraception, an important issue not least because family planning is widely deemed a basic human right.