Adventures of a Gringa

Q&A with the Drunkeynesian: Brazil's Food Inflation

Earlier this month, I reported on Brazil's tomato crisis, with prices of tomatoes and other vegetables rising. Soon after, the international press also began covering this issue (see Beyond Brics, FT, Bloomberg, AP, NPR, and Quartz). There were even reports in the Brazilian press of tomato smuggling across the Argentine border. One of Brazil's most popular TV personalities, Ana Maria Braga, wore a "tomato necklace" on TV and joked she was wearing gold. This weekend, two of Brazil's largest weekly magazines put tomatoes on the front cover. Much of the coverage, both domestic and international, focuses on the threat of inflation, and what rising inflation could mean for next year's presidential election. There's also the issue of consumption. Valor reported last week that due to rising food prices, supermarket sales fell 2.1 percent in February, though families spent 9.3 percent more than in February 2012. In the last week or so, tomato prices have started to go down, though prices of other vegetables--namely onions and potatoes--increased by 15 and 25 percent, respectively. Onions, too, are being smuggled across the Argentine and Paraguayan borders.

To determine what is really going on with food inflation, I talked to São Paulo-based economist Luciano Sobral, also known as the Drunkeynesian, to get his views on whether this a long-term trend, a short-term problem, or a symptom of other economic forces at play.

Tomatoes, onions, and other vegetables and food products have risen over the last year. There are climatic reasons (drought, rains) and agricultural reasons (less area planted), but what are the bigger economic forces at play?

I don’t think there are other bigger economic forces acting here, since demand for those items is pretty much stable. As you mentioned, there was a supply shock caused mainly by climatic reasons (heavy rains in the Southeast, a severe drought in the Northeast), and since arbitrage is not possible for several products (there’s no international market, at least not a liquid one where players can hedge or speculate), prices skyrocketed. Curiously, the prices of exchange listed agricultural commodities have been falling consistently since last September, so if there’s any external factor in foodstuff items it should lead to lower domestic prices.

How is food inflation going to affect inflation overall? The economy overall?

Of course the first effect is a spike in headline inflation. The infamous tomato story caused a frenzy on local media (two of the largest weekly magazines in Brazil are currently running cover stories about inflation and food prices), and called attention to a deeper, more structural problem: headline inflation is so sensitive to food prices because ex-food inflation has been quite high. Service prices are rising more than 10 percent per year. There’s a huge adjustment in relative prices going on, and it’s not favourable to capital or investments. Thus the conundrum: the current situation is very desirable politically (low unemployment and real wages rising), but it doesn’t seem sustainable, since overall profit margins look already quite weak and don’t attract new private investments. Dilma has the political incentives to postpone an adjustment until after next year’s elections, but, as a long term growth strategy, Brazil cannot rely only on state-lead, profit-insensitive capital investment.

Do you think food-driven inflation will continue into next year? Or is this a short-term issue?

I don’t see a major global uptrend in food prices, so I’d bet this is a short-term issue. Shocks related to climate are pretty much random, impossible to forecast. What’s been more or less established is that they tend to dissipate quite quickly, as soon as the climate turns favorable or higher prices attract new producers or importers to the market. An example: tomato prices hit R$12/kg a couple of weeks ago; this weekend I bought beautiful tomatoes at a supermarket for less than R$4/kg.

What does the price spike of certain foods reveal about the Brazilian economy?

Despite all the progress of recent years, Brazil remains a (somewhat) poor and (very) unequal country. The substantial weight of food prices in the average consumption basket (and, consequently, in price indexes) is an evidence of that: everytime certain food prices rise, there’s a national concern. This is similar to what happens with tortilla prices in Mexico or rice prices in some poor Asian nations. Another interesting aspect is the dependence of Brazilian food markets on local producers, since importing is not a viable emergency solution (think of taxes, red tape, complicated logistics). This tends to make supply shocks more frequent and persistent. Finally, it shows the old obsession of the country with inflation, as if it were part of our collective conscience, and how there’s little space in current inflation to accommodate shocks within the established inflation target range (2.5 percent to 6.5 percent, with a center of 4.5 percent). Brazil indeed has an inflation problem, although I don’t think it’s as dramatic as the media and some economists are painting it; only it serves as an important alert to more complicated structural issues.

Image: Courtesy of Drunkeynesian

Brazil's Tomato War

Brazil has a tomato problem. In recent weeks, the price of tomatoes has skyrocketed, making it as expensive as meat and chicken in some cases.

In supermarkets in parts of São Paulo state, Brazil's second-largest tomato producer, the price of tomatoes rose by 346 percent, from R$1.90 to R$8.49 per kilo. Wholesale prices there have also risen above 330 percent. In states like Mato Grosso do Sul and Pernambuco, prices spiked above 200 percent. In Goiás, the country's largest tomato producer, tomato prices hit an all-time high of 150 percent in April.

Nationwide, tomato prices increased 17 percent in the last week alone. Prices went up 70 percent from January to March, and rose a total of 150 percent in the last 12 months.

For an international comparison: At my local grocery store in New York, vine tomatoes are on sale for $1.97 per pound, or about R$8.61 per kilo. In São Paulo, vine tomatoes at Pão de Açucar are selling for R$14.39 per kilo--67 percent more than in New York. Even in Alaska, tomatoes cost less than in some Brazilian cities.

A number of factors are at play. Areas of tomato cultivation were reduced nationwide, in part due to heavy rains in the South and a record drought in the Northeast. There was also overproduction of tomatoes last year, which led to fewer areas of cultivation this year. In total, the area covered by tomato fields fell 16 percent in Brazil; in Goiás, by nearly 42 percent. The result of falling supply? Higher prices.

On the agricultural side, there were other factors. Some crops were hit by diseases. Agricultural labor doesn't come cheap. Small-scale farmers are often unable to invest in high-tech equipment, opting to pay for workers instead. Another theory is that the lack of policies to guarantee a minimum price based on production costs has also had an influence. Then there are the overall economic causes. High production costs, as well as high price of diesel, contribute. There's also the "Brazil cost," which includes expensive transportation costs and high taxes. 

The price spike has led to jokes in the media and on the internet, spawning political cartoons such as a robber demanding tomatoes instead of a wallet, and a woman complaining that tomatoes are too expensive to throw at politicians. It's inspired Facebook memes, showing TV host Silvio Santos giving away tomatoes as a prize, an engagement ring made with tomatoes, and an image of a robber saying: "ATMs are over with. The game's in boxes of tomatoes now."

Some people are simply cutting back on tomato purchases. But others, like an Italian restaurant in São Paulo is fighting back and "declaring war" on tomatoes. Nello's Cantina and Pizzaria announced on Facebook earlier this week that it would stop buying tomatoes and serving dishes using tomatoes until the price goes down--a fairly extreme decision for an Italian restaurant. Today, though, the restaurant posted a video showing owners negotiating 25 boxes of tomatoes at a wholesale market. (Incidentally, this is the same restaurant that, like several other upscale restaurants in São Paulo in recent memory, saw armed thieves invade the premises and rob 60 customers about a year ago.)

Some say prices will come down soon, though it's not likely to come down to previous lows. Other vegetables, like onions and carrots, have also become more expensive, hitting the highest prices in 14 years. Is this just a price flux? Or is this a sign of more inflation to come--which could have a bigger impact ahead of next year's election? We'll have to see. For now, Brazilians may just have to cut back on salad.

**Updated 4/6 with additional info on Alaska prices, corrected tomato cost per real in NYC.

Image: Angela Leese

Building Startups in Rio: An Interview with 21212's Benjamin White

Because of a slowing economy, Brazil may no longer be the darling of international investors and media, but one American is hedging his bets on the Brazilian market. Benjamin White, one of the co-founders of Brazil-focused startup accelerator 21212, moved from New York to Rio in part because of his belief in the vast potential of Brazil's digital space. He's combining New York know-how and pragmatism with Rio ingenuity and creativity to build some of the most innovative startups in Brazil.

How it All Began

White previously worked as vice president of digital media at MTV and as chief creative officer at Sling Media in New York, as well as an angel investor. But after marrying his Brazilian wife in 2009 and spending six months traveling around Brazil, he began to set his sights on the South American country. At the time, "things were really shaping up in Brazil," White said. He had an epiphany that he wanted to do something in the digital space but was uneasy about investing his own money, so he spent a year building his network in Brazil and meeting companies. "I kept getting more and more convinced that the opportunity was massive," White explained.

So he and his Brazilian partners decided to start an accelerator, which has similar goals to that of an angel investor. White and his partners saw a need to bridge Brazil's experience gap, especially when it came to building digital businesses. White noted that Brazil hasn't had a long tradition of entrepreneurship, but has seen a "meteoric rise" in digital penetration. He sees Brazil's opportunities in the digital space as an "invitability story." With only 40 percent of the population online but as the number 2 country in Facebook and Twitter and exponential growth in e-commerce, "the opportunities in the digital space are inevitable."

The Rio-New York Connection

White hoped to build a bridge between Brazil and the United States through the company, both literally and figuratively. He hails from New York, and his partners from Rio, and they opened offices in both cities. They named the company after the phone codes of Rio (21) and New York (212). White believes 21212 has a distinct advantage over other similar companies operating in Brazil because of the U.S. connection. Since the United States is in a leadership position in tech and internet development, White said, it's helpful to not only source mentors and best practices from successful U.S. companies, but it's also easier to launch Brazilian companies in the U.S. (Plus, White pointed out, New York beats Silicon Valley when it comes to doing business with Brazil, given fewer time zones and flight times separating the two.) While 21212's vision is to build companies in Brazil, for Brazil, it also aims to help Brazilian companies expand to the U.S. market. Queremos, an innovative crowdfunding music platform in 21212's second class, is now setting up shop in New York, and launched as WeDemand! for the U.S. market.

The Startups

Many of 21212's companies have found something unique about the Brazilian market and built incredible web-based solutions. Pagpop, for example, is an e-payment online platform started by a dentist who was only able to accept cash and checks from patients, given the difficulty in acquiring a credit-card processing machine. (Until a few years ago, White said, there was a duopoly for these machines, but now that's changing because of legislation to open up the space.) ResolveAí is a mobile app that allows users to order cabs and track their location. "Now you can actually see if the cab is really 5 minutes away," explained White, "which is a huge confidence-builder." The company has expanded from Rio to 23 other cities throughout Brazil. ZeroPaper is a cloud-based accounting solution for small businesses, created after entrepreneurs discovered that many small business owners in Brazil either still use pen and paper for their accounts, or use Excel spreadsheets or paid desktop programs. The program is online-based, free, and easy to use. BidCorp is another example of a web-based solution for businesses. This site works as a marketplace for surplus assets from large construction companies who have trouble managing equipment. Bidcorp resells everything from heavy machinery to office equipment, helping companies become more efficient and manage their inventory. "Nobody's doing what they're doing," said White.

As of December 2012, 21212's companies had raised R$5.5 million, which has increased since. The accelerator recently accepted its third class, and now has 27 companies.

Streamlining the Startup Process

21212 is using New York pragmatism and a no-nonsense approach to building startups, in what White calls an ecosystem-building mode. "Our number one basic thesis is that there's an abundance of opportunity in Brazil and a dearth of resources," White explained. So 21212 is working to take advantage of mentors and lessons from abroad from people who built similar businesses to apply them in Brazil.

One thing the company is doing is systematize the process of starting business."There are all sorts of barriers to doing business in Brazil that you have to figure out how to overcome in order to seize the opportunities," White said. "Setting up a company in Brazil is notoriously difficult," he noted, "and is a huge obstacle for startups." It can take months. So 21212 sought to become as efficient as possible, with one Brazilian and one American lawyer on staff doing the exact same paperwork for all of the startups. The system is now so efficient that the company is able to do it faster than almost everyone they know. From an investor's perspective, White says, "I want my founding teams working on their product and their business, not at the cartório for three weeks straight."

Visas are another obstacle, since there's a lot of interest from foreigners who want to work in Brazil but it's difficult to get visas for them to work with startups. From the policy side, "The jury is still out if there's the political will to do what's best for the country," White explained. "For me, it's clear you have to open up and bring talent in."

Rio: Brazil's Silicon Valley?

For White, Rio is a natural location not only for an accelerator, but as a potential Silicon Valley in Brazil. Since companies have to import talent and foreign money, Rio is the place where that can happen, White believes, because foreigners want to go there to have the full Brazil experience. "It's an emotional, lifestyle thing, not a bottom line, money-making thing," White said, "but it's probably more powerful of any other aspect of 'why Rio' question." Botafogo, where 21212 has its offices, is becoming the city's tech hub with a growing number of startup companies. "Startups cluster to rely on each other," White noted. Botafogo has the advantage of being more "homey" as well as being a convenient location with easy transportation, near the airports, and close to other parts of Zona Sul where international visitors stay. White notes that São Paulo is close enough to do business, but isn't as appealing for foreigners coming from big cities. "If you need to get your best talent to work in Brazil, Rio is a much easier sell," he said.

Image: Courtesy of 21212

Brazil's English Language Challenge

You've probably read about how different cities in Brazil are preparing for the World Cup by offering English courses to certain groups, from taxi drivers in Rio to prostitutes in Belo Horizonte. With a year and a half left before the mega-event, some are scrambling to teach foreign languages--especially English--in preparation for the expected flood of foreigners in the next few years. There's also growing consciousness about the fact that the lack of English speakers in Brazil means the country is losing money, not only in tourism but business, too.

Unfortunately, a lot of the focus on expanding the pool of foreign-language speakers has to do with Brazil's upcoming mega-events. A very amusing report from Correio Braziliense, for example, found few English and Spanish speakers in Brasilia, where a McDonald's employee pointed a Spaniard to a bathroom after he asked for a vaso (cup, in Spanish), and a host at a fancy restaurant simply hung up after discovering he was unable to understand the foreign caller. Meanwhile, the Belo Horizonte sex workers story made instant headlines around the world. But tourists aren't going to just be lost during the World Cup or Olympics; this is a problem now, and will be after 2016. And even more importantly, the shortage of English speakers adds to the so-called "Brazil cost," a combination of factors that makes Brazil less competitive, across the spectrum of industries.

Luckily, President Dilma Rousseff and some in her administration understand this: Brazil's language gap is a bigger, long-term problem. In late December, Brazil's Education Minister Aloizio Mercadante announced that the government will launch "English Without Borders" in March. The program--which echoes the government's STEM initiative to send students abroad to study science and technology--aims to benefit half a million students over the next year. Initially, 100,000 students with high marks on the country's college entrance exam will receive access to an online English course ("the best in the world," Mercadante says). Students will take the TOEFL exam to see which level they qualify for, and 10,000 students with high scores on this test will receive preferential access to English courses at federal universities. Later, the government hopes to expand the program to Spanish, German, and Chinese. According to a brief report on the plan this week, it's the most ambitious English-language program ever launched by the government.

Still, key questions remain. Will distance learning really be effective? Will the classroom courses have qualified teachers? Will the program be extended past 2014? One certainly hopes so.

But like with many of Brazil's education challenges, an even better approach would be starting much earlier--on the elementary level, as well as the secondary and university levels. It's the difference between CEOs who cannot communicate with foreign colleagues and five-year-olds who have never been to an English-speaking country but speak like California natives. They both exist now. If a government initiative was created for elementary students, particularly in public schools, imagine what the difference would be in 20 years. Hopefully, English Without Borders is the start of more expansive foreign language programs to come.

Image: Acariquara. Shirt captured at a Walmart in Bahia. The first dialogue bubble reads: "It's coll."

Brazil In The Year Ahead

The big story making headlines as we get closer to 2013 is that of Brazil's slowing economy. While that will continue to be an ongoing issue to watch, here are a number of other things to keep your eye on in the year ahead.

Issues to Watch: Brazil

• Oil and gas. With the first oil concessions in five years due to take place in 2013, this is the industry to watch next year. But the ongoing royalties fight in Brasilia isn't over yet, and the royalties law could end up in the Supreme Court again if Congress overturns Dilma's partial veto.
• Brazil's new middle class. As one of the most compelling tales of Brazil's growth, this group is the one to watch--especially to see if it can be sustained or grow amid sluggish GDP growth and rising consumer debt.
• Airport and port privatizations. Travelers eagerly await airport upgrades; businesses hope for more efficient ports. The process could be long, but there should be movement in this area next year, especially after the recent announcement that Rio and Belo Horizonte's international airports will also be privatized.
• Construction and housing. In spite of slower growth, this is an area that continues to chug along. FipeZap estimated that real estate prices rose by nearly 14 percent this year and doubled within the last 3 years. The government also hopes to use this sector to boost growth, and the subsidized housing program Minha Casa, Minha Vida is full speed ahead.
• BNDES. Brazil's development bank lent nearly $60 billion through November of this year and could lend up to $73 billion by the end of 2012. Keep an eye on where BNDES is spending, particularly the Brazilian multinationals and major domestic projects, like the controversial Belo Monte hydroelectric plant.
• Government corruption. Will the mensalão defendants actually go to jail? Will Dilma continue to show no mercy for those accused of wrongdoing? Will new transparency laws help uncover new scandals?

Issues to Watch: Rio

• UPPs. Violence has flared up in several of the city's "pacified" favelas, and most of the on-duty military police that died this year died in UPP favelas. Keep an eye on how current UPP favelas are faring in terms of security, as well as plans for new UPPs in other favelas.
• Transportation construction. The bus rapid transit system is underway and operating in a section of the city, with four new stations inaugurated last week. Four more stations are due to open in January with ongoing construction throughout the city. But getting the system online isn't the only challenge; people keep getting hit and killed by the BRT and many have complained about overcrowding. Expanding Rio's metro system is also underway with a price tag of $3.6 billion.
• Militias. The government has focused much of its security strategy on combatting drug traffickers and bringing a permanent police presence to favelas. Will it finally turn the heat up on the city's paramilitary groups?
• Favela removals. Forced evictions from favelas to make way for mega-event construction and urban renewal have stirred controversy on an international scale. Keep an eye out for how these removals play out.
• Mega-event preparations. From stadium construction to training programs, this is an ongoing area to watch. Maracanã Stadium renovations are due to conclude by the end of February, likely over budget. Maracanã is also due to be privatized next year, so keep an eye out for who wins the prize.

People to Watch

• Guido Mantega: Will he hang on as finance minister? If an Economist article won't be his downfall, could more disappointing growth numbers be the final straw? Or will he stay on until the bitter end?
• Joaquim Barbosa: The new president of the Supreme Court became something of a national hero for his hard-line approach during the mensalão trial. But he also decided against immediate imprisonment for those convicted in the trial. Beyond the mensalão, keep an eye on Barbosa and major STF trials next year.
• Lula: The heat recently turned up again from mensalão accusations, though it seems likely he'll remain unscathed for now. But with presidential elections in 2014, will he decide to become a candidate or let Dilma run for reelection?
• Eduardo Campos: The governor of Pernambuco looks like a likely presidential candidate in 2014. Watch for campaign announcements next year.
• Marco Antonio Raupp: Brazil's minister of science, technology, and innovation could be the spokesperson for some of the government's most interesting new initiatives. In November, he announced the launch of Start-Up Brasil, a $40 million project aimed at Brazilian startup companies.

People to Follow

• Brazil's economy - Luciano Sobral, the Drunkeynesian
• Brazil's new middle class - Renato Meirelles of Data Popular
• Brazil tech news and startups - TNW's Anna Heim
• Government transparency - Observing Brazil's Greg Michener
• Everything Rio - RioReal Blog's Julia Michaels
• Rio mega-event preparations, favela removals - Christopher Gaffney of Hunting White Elephants

Photo: Charlie Phillips

Muito Além do Peso

With a bigger economy and a growing middle class, Brazil is facing new public health challenges, including an obesity epidemic. A documentary released in Brazil last month called Way Beyond Weight delves into children's obesity in Brazil, an increasingly worrying issue given that around a third of Brazilian kids are overweight. Some of the themes mirror the same issues in the United States--which has had a longer obesity epidemic--ranging from fast food advertising aimed at kids to children unable to identify basic produce.

The film also reveals other staggering statistics, like the fact that an estimated 56 of Brazilian babies under the age of 1 drink soda. There's even a scene showing a mother bottle-feeding a baby with soda.

It also delves into the growing presence of junk food and fast food companies in Brazil and how they target children. One scene even shows a Nestlé boat arriving in sparsely populated areas of the Amazon; these boats carry tons of cookies to this region. One of the producers noted that while they were filming, he met an indigenous chief who gave tips for making Ramen noodles.

Child obesity in Brazil isn't limited by social class, and the film aims to show children across the socioeconomic spectrum throughout the country. In a few scenes, the movie shows kids unable to identify vegetables.

Brazil's obesity epidemic still hasn't received enough attention domestically, so the film is a good start to put this issue on the policy radar.

To watch more clips from the movie, click here.

The Strange Tale of Female Sterilization in Brazil

Tubal ligation, a form of female sterilization, has long been one of Brazil's most popular forms of birth control--despite the fact that it was illegal until 1996. Known as laqueadura tubária in Portuguese, or "tying the tubes," the procedure was often done in conjunction with a cesarean section, allowing doctors to covertly provide the operation after a legal one. Perhaps as a consequence, Brazil now has one of the highest rates of C-sections in the world, even after sterilizations were legalized. But the law didn't necessarily make sterilization access easier. The law requires spousal consent, which can limit access for single women or those whose husbands refuse to allow the surgery. The law also forbids sterilization right after a woman gives birth. One study found that private doctors have tended to ignore this rule, but public doctors sometimes adhere to it--which can limit access to this form of birth control for poorer women.

Passed in 1996, Brazil's family planning law legalized both male and female sterilization, which was permitted for any "man or woman with full citizen’s rights and older than 25 years of age, or who has at least two living children, such that s/he observe at minimum a 60-day period between the request and surgery, in which the person must have access to fertility regulation services, including counseling by a
multidisciplinary team, in order to discourage premature sterilization."

But the law also states that a patient must seek consent from his or her spouse in order to have surgery. In practice, this sometimes means women can be denied sterilization surgery if they are unmarried or dont have permission from their husbands. Men, meanwhile, are unlikely to be asked for permission from their spouses to undergo a vasectomy. A bill is under consideration in Congress to remove the consent requirement from the law. "In my opinion, the body of another person is viewed in the family planning law as if it was a good, like a car for sale. It's a distortion. Sexual and reproductive rights belong to each person," the bill's author, Congressman Paulo Rubem Santiago, said in June.

Until 1996, female sterilization was illegal, outlawed by article 16 of decree 20931 of 1931 and by article 129, paragraph 2.III of the Brazilian Penal Code of 1940. Punishment ranged from two to eight years in prison for doctors who carried out the surgery. Despite being banned, the practice was widespread throughout the country, even in public hospitals. By the early 1990s, female sterilization was the most common form of birth control in Brazil, due in part to limited access to other types of contraceptives. Less affluent women also often lacked family planning knowledge and access to such information. In 1996, 40 percent of Brazilian women (married or in unions) aged 15 to 49 had sterilization surgery; of those women, 57 percent had the procedure before the age of 30 and 34 percent had only one or two children. In poorer parts of the country, sterilization rates were higher. In 1994, an estimated 76 percent of women of reproductive age in Maranhão had undergone the surgery, along with 72 percent in Goiás and 60 percent in Pernambuco.

Because tubal ligation was illegal, doctors often performed the procedure following cesarean section surgeries. A 1996 survey found that 59 percent of tubal ligations took place in conjunction with C-sections--many of which were performed only to conduct the sterilization. A 1991 estimate put it even higher, at 75 percent of all tubal ligations performed with C-sections. By performing the two surgeries together, the doctors were able to perform the banned surgery following a legal one, and also charged double. Meanwhile, patients footed the bill for the sterilization. C-sections are still popular in Brazil--today, around 50 percent of all pregnancies are delivered using a cesarean, and 82 percent of women with private insurance get C-sections. Some speculate that Brazil's history of sterilizations performed with C-sections is the reason the country has one of the highest rates of cesareans in the world.

Tubal ligation is controversial in part because of its political uses. Despite being illegal, some state governments promoted the practice in the 1990s, offering the surgery for free. In 1991, Congress launched an investigation of "mass sterilizations," also looking to see if black women were sterilized at higher rates. (It found there wasn't discrimination, but a need to regulate the practice.) Local politicians throughout Brazilian sometimes offer to pay for sterilizations in exchange for votes. "We have a culture of sterilization in Brazil. It's nationwide. A lot of politicians are elected because of their sterilization promises," said Jurema Werneck, executive director of women's health organization Criola told the Washington Post in 2004. In the past, some employers even required women to provide proof they had been sterilized in order to get a job, as they did not want to offer maternity leave.

With the passage of the law in 1996, the number of tubal ligations remained high. A 2001 survey found that nearly 1 in 2 Brazilian women had been sterilized. However, the law outlawed women from having postpartum sterilization surgery in an attempt to reduce unnecessary C-sections. One study in 2003, however, found that private doctors were ignoring this part of the law and still performing sterilizations with C-sections. Public hospital doctors, meanwhile, were less likely to give postpartum tubal ligations. In other words, poorer patients--the ones less likely to have access to other forms of birth control--had less access to sterilizaton.

Photo: Governo da Bahia