Health centers in the city of São Paulo require the husband’s consent for the insertion of an IUD (intrauterine device) in married women. In early August, a report from sheet showed that this practice, despite being illegal, was also adopted by health plans in São Paulo and Minas Gerais.
There are at least seven UBSs (Basic Health Units) in São Paulo that ask for the spouse’s authorization to undergo the IUD placement procedure, a long-term contraceptive method (understand how the method prevents pregnancy).
They are: UBS Ferroviários, UBS Chácara Cruzeiro do Sul, UBS Jardim Santa Maria, UBS Vila Santana and UBS Cidade Tiradentes, on the east side; UBS Carandiru, in the North Zone; and UBS Vila Sonia, on the west side.
Sought by the report, the City of São Paulo said that the only requirement should be the patient’s consent and that it will reorient the aforementioned health units.
These units are outsourced and managed by the social organizations Casa de Saúde Santa Marcelina, SPDM (São Paulo Association for the Development of Medicine) and Seconci-SP (Social Service of Civil Construction of the State of São Paulo). Most of these UBSs are concentrated on the outskirts of the city.
After being informed that SUS (Unified Health System) units were demanding the spouse’s consent to perform the procedure, the reporter, without identifying himself, contacted the health centers by telephone. To obtain the information, it was necessary to declare interest in placing the contraceptive.
Officials confirmed the need for the signature of both partners. In most of these units, it is also mandatory to participate, before the insertion of the IUD, in a family planning group, in which doctors, nurses, psychologists and social workers provide counseling for the couple.
By law, however, the family planning step should only be mandatory in cases of surgical sterilization.
In the case of UBS Jardim Santa Maria and UBS Carandiru, employees informed that there are some situations in which the spouse’s consent is required, but not in others. Thus, the woman interested in using the IUD would need to go to the place to have her case evaluated by the nurse or social worker.
In August, the sheet revealed that health insurance also required the husband’s consent for the insertion of contraceptives in married women. The Unimed cooperatives of João Monlevade and Divinópolis, in Minas Gerais, and Ourinhos, in São Paulo, made this demand.
After contacting the report, the units in Divinópolis and Ourinhos said they had abandoned the imposition. Already the cooperative João Monlevade denied the requirement. He said he only recommends that the consent form be shared.
The report of sheet led Procon to ask for explanations about the practice. Some federal and state deputies also mobilized to present bills with the objective of prohibiting the requirement of the husband’s consent for insertion of the IUD.
The imposition of more steps to access contraceptives causes a reduction in the use of the methods, assesses Ana Luiza Vilela Borges, a professor at the USP School of Nursing. For her, women should have as few barriers as possible to using a contraceptive method.
“Women have to go to the unit several times to make an appointment, go to the group, and after two months they will have a time to put it on. There are several steps added, and with the IUD this gains a much greater proportion”, says Borges.
“And then the husband’s consent is added, which is something absurd, but it enters this list of additional criteria that are not established in any protocol, but the services incorporate on their own”, he says.
The study “Organizational barriers to the availability and insertion of the intrauterine device in primary health care services”, published in 2017, showed that the excess of criteria for the insertion of contraceptives, such as the obligation of unnecessary tests, prior scheduling – the waiting time to put the device on exceeded one month in the cities evaluated in the survey – and the mandatory participation in educational groups, such as family planning, are barriers that prevent women from having access to the IUD.
Because they receive people with different reproductive intentions, analyzes Borges, educational groups become nonspecific, being just one more obligation that interested parties need to go through to achieve the desired method.
“We criticize this a lot because counseling for those who no longer want to have children and want a definitive method [para evitar a gravidez] it has to have a profile, a character, it has to address some things. For younger women who just want to space out one pregnancy and want a short-term method, you have to approach others.”
The IUD is a long-acting “T”-shaped contraceptive. It is introduced into a woman’s uterus through the cervix. There are two types: hormonal ones, which release levonorgestrel (a type of progesterone), and non-hormonal ones, which have copper or silver in their composition.
In SUS, the main device available is copper. Hormonal is offered in a restricted way, only in cases such as the treatment of chronic diseases.
Priscila Souza (fictitious name), 33, was one of the patients at UBS Vila Sônia who needed her husband’s consent to put on the contraceptive. The two went to the site with the intention of choosing a contraceptive method, but when they arrived at the unit, they discovered that for any long-term procedure, such as the IUD, she would need the consent of her spouse.
From then on, it took about two months before she could have the IUD inserted. In addition to signing the documents, they had to take exams and attend lectures, medical appointments and sessions with psychologists. After all these procedures, they still had to wait a period of about two weeks to say that yes, it was the couple’s desire to insert the contraceptive.
“I’ve always known that I needed his signature for me, just as he would need mine for him [no caso de uma vasectomia]. This for me was normal. I think this is common at UBSs in São Paulo”, he says.
The requirement of the spouse’s consent is provided by law only in the case of surgical sterilization, such as vasectomy or tubal ligation, according to Law 9,263 of 1996, which provides for family planning.
Silmara Chinellato, a professor at the USP Law School, says: “Women have the right to their bodies, as a right of personality recognized by the Civil Code, by scholars and by the courts. This right is very personal, that is, it is hers alone”.
If any interested party is faced with the requirement, they can seek the Public Defender’s Office or a private lawyer to ask for judicial exemption from the marital authorization. Chinellato states that it is necessary to check on a case-by-case basis, but, in theory, those who have already gone through this situation can claim compensation.
The City of São Paulo, through the Municipal Health Department, states that, to insert the IUD in municipal network units, it is only necessary to fill out the consent form by the patient and that it will reorient the units mentioned by the report.
Casa de Saúde Santa Marcelina says that a term is applied that must be signed by the patient, and that the partner’s consent is not required.
SPDM, on the other hand, states that the insertion of the device does not depend on the spouse’s consent and that there is no instruction from the direction of the units to request consent.
In a note, they also say that there are no documents that require this signature.
Seconci-SP was also contacted via email and telephone, but did not respond until this article was published.