practiced. There is also concern about the increase in caesarean sections, from less than 20 percent of all deliveries in 1980 to 50 percent in 1993, as studies indicate that they are often the occasion for illegal tubal ligations. It is estimated that more than 9 million Brazilian women have undergone tubal ligation, making female sterilization the most common form of birth control in Brazil. For many of these young women, such an irreversible step is far from ideal.

This heavy reliance on oral contraceptives and sterilization has other serious implications in a country where sexually transmitted diseases are widespread. One consequence is a reduction in condom use, hastening the incidence of such diseases. Brazil has one of the highest HIV infection rates in the Americas, with an estimated 700,000 people carrying the virus. As heterosexual and perinatal transmissions increase, the virus is expected to spread even more rapidly. Women now account for one in six new AIDS cases in Brazil, compared to one in 123 new cases a decade ago.

Although AIDS service organizations have come to recognize the threats to Brazilian women posed by HIV/AIDS, they generally have not seen them as related to women's reproductive health. Similarly, although women's organizations have developed impressive activities to promote women's reproductive health, they have been slow to respond to the potential danger of HIV/AIDS.

The Foundation has supported institutions working to develop a collective response to these problems. Grupo Pela Vidda, one of several grantees working on behalf of AIDS victims, has formed a women's group that is addressing issues of particular concern to HIV-positive women. Pela Vidda is also dealing with the challenges women face as the principal care givers for infected relatives.

At the State University of Campinas, Foundation funds support research on the risks associated with unnecessary caesarean sections and sterilizations, induced abortions, and the uninformed use of oral contraceptives. Additional research will analyze the behavioral, social, and cultural circumstances under which such risks are taken.

These efforts should help provide the basis for policies and practices that go beyond a narrow focus on fertility control to emphasize reproductive health in its broadest sense.