Infertile Ground Is Sown in Brazil

"It is a priority because we live in a country where the birth rate is higher than the gross domestic product," he said. "In other words, what grew was the misery. In some areas of Brazil, you will find women with up to 20 children.

"It's simple math: A woman can provide more easily for one child than two. Lowering the birth rate gives us an opportunity to increase per capita income."

Few women, he said, regret their decision to be sterilized.

But Santos has been reconsidering. A widow, she said that she is thinking about remarrying and has discussed having a second child with her boyfriend.

"But I can't now," she said. "I do regret it a little bit."

Rosangela de Jesus Santos, who had her sterilization arranged by Trinidade two years ago, said she has never regretted her decision. At 33, she has a 16-year old son, a fourth-grade education and a live-in boyfriend. Neither has a job.

"There is a problem with women having more children than they can take care of," she said. She is unable to provide for her son, so he lives with her parents. She searches for work every day, she said.

"What I really need is a job," she said. "I go from one place to another all day long but no one here is hiring. That's my number one problem."

She recalled Trinidade visiting the clinic waiting room and handing out campaign literature on the day she had her sterilization. Most of her friends who had their surgeries arranged by Trinidade voted for him, she said. She did not.

Voting is legally mandated in Brazil. Liliane Tavares, 24, a medical technician, said there are two things she is certain she will never do: get sterilized and vote for Trinidade.

Trinidade arranged for her mother's sterilization during his first campaign for city council more than 13 years ago in the days following the birth of Tavares's younger brother, the family's fourth child.

Her mother later regretted becoming infertile, Tavares said. "She told me that she really wanted to have six children," Tavares said.

Tavares, who thinks there is a misguided political focus on the birth rate in Brazil, said she was applying to medical school and hopes to become a gynecologist.

"I want to provide real health care to black women," she said. "I want to provide them with more options, not less."