In São Paulo, Access to Free Birth Control Echoes Inequality

Free condom dispensers in São Paulo. Photo by Sydney Speizman.
Free condom dispensers in São Paulo. Photo by Sydney Speizman.

By Sydney Speizman

The first time I came across a bin of preservativos gratuitos sitting on the sidewalk in downtown São Paulo, I was taken aback. I couldn’t believe that free condoms were not only available but openly promoted in a notoriously Catholic-dominated society. I wrote the sighting off as an anomaly and didn’t expect to continue running into free condom bins during my time studying abroad in the city.

But there they were—mounted on the wall outside of a basic health clinic in a historically immigrant neighborhood, in a freestanding dispenser in front of the main entrance of a diversity center in the old downtown, and scattered around the city in many other highly frequented areas.

This visible supply of condoms reflects the progressive nature of the Brazilian universal healthcare system. Everyone living in São Paulo has the right to medical care, including free contraception. In order to meet this need, each neighborhood in São Paulo is assigned to a basic health unit. Each of these units is supposed to have a supply of condoms and should provide patients with free birth control prescriptions.

In practice, however, access to contraception from public health units varies depending on the neighborhood’s location and is especially limited in the comunidades that lie on the periphery of the city, due to a lack of doctors and shortage of contraceptive supplies.

In Jaçanã, a comunidade in the northeastern region of São Paulo, a woman who works at a local preschool told me that two-thirds of teenage girls are pregnant because they receive limited sex education and have no access to contraception. Whether or not this statistic is exact, the dearth of family planning resources and prevalence of teen pregnancy in many of the comunidades is undeniable. The inability to obtain adequate contraception and sexual education has severe implications in the crowded, under-resourced comunidades.

There are also differences in access to contraception within neighborhoods. In the public health system, each neighborhood is divided into zones and health practitioners in the local basic health unit are assigned to these zones. Therefore, the zone in which people live determines what doctor they are assigned.

According to a doctor I spoke with in Bom Retiro, a diverse immigrant community, this zone system has an impact on the family planning information and care that patients receive, depending on the religious beliefs of their assigned doctor. He once worked with a doctor who was very religious and, as a result, prescribed birth control infrequently. Because of this, the pregnancy rate in the zone she worked with was significantly higher than in his zone, even though the two areas are adjacent to each other.

Although there is room to reduce the inequality along spatial divides as well as between the country’s public and private health systems, the Brazilian healthcare system is making positive strides in increasing the availability of contraception and raising awareness of safe sexual practices. The U.S. should follow Brazil’s example and work to expand access to family planning rather than continue to restrict reproductive rights.

Sydney Speizman is a student of public policy at Duke University. She is studying abroad in Brazil, South Africa, and India.

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