Female reproductive system Freepik/Disclosure The number of tubal ligations performed by the Unified Health System (SUS) in Campinas (SP) began to surpass the number of vasectomies after changes in legislation that expanded access to voluntary sterilization. Data sent by the Municipal Health Department at the request of g1 show that, in the years 2024 and 2025, female procedures surpassed male procedures, reversing a trend observed in previous years. The numbers indicate that: in 2024, 826 tubal ligations were performed, compared to 677 vasectomies; in 2025, the difference remained: 693 tubal ligations and 469 vasectomies. The reversal of scenarios occurs after the entry into force, in March 2023, of the new Family Planning Law, which reduced the minimum age for voluntary sterilization from 25 to 21 years and removed the requirement for authorization from the spouse to carry out the procedure. Before the change in legislation, vasectomies were in the lead. In 2020, Campinas recorded 220 male surgeries, compared to 119 tubal ligations. In 2021, there were 193 vasectomies and 99 tubal ligations. In 2022, there was growth in both procedures, but the difference remained significant: 714 vasectomies and 226 tubal ligations. In 2023, the first year after the change in the law and with the post-Covid-19 pandemic easing, both procedures grew. Vasectomies reached the highest number in the historical series, with 829 surgeries, while tubal ligations jumped to 574. The following year, however, the scenario changed, and female sterilizations became the majority. Patient profile Among the men who underwent vasectomy in the period analyzed, the majority were between 30 and 39 years old, an age group that accounts for 1,645 procedures. Next come patients aged 40 to 49 (996) and 21 to 29 years old (414). There were also 208 surgeries on men aged 50 to 59, ten between 60 and 69 years old and five on people aged 70 or over. In tubal ligations, the concentration is also among women aged 30 to 39, with 1,507 procedures. The 21 to 29 year old group appears close behind, with 876 surgeries, followed by women aged 40 to 49, with 263. There were also three procedures on patients under 21 years old, a situation provided for by law for specific cases. Female protagonism in reproductive planning The data shows that the change in rules facilitated access, especially to tubal ligation. Between 2022 and 2024, the number of procedures practically quadrupled, going from 226 to 826. In the same period, vasectomies also showed growth in relation to previous years, reaching a peak in 2023, but falling again in the following two years. Although male surgery is simpler and less invasive than female surgery, experts consulted by g1 assess that the responsibility for reproductive planning still largely falls on women. For them, the change in legislation expanded female autonomy, but highlighted a demand that already existed. READ ALSO: Implanon in the SUS: Campinas applies 2,800 contraceptive implants in 4 years; see how it works Coordinator of the Women's Health area at the Campinas Health Department, Mirian Nóbrega states that the main impact of the new law was to eliminate a barrier that made access to the sterilization procedure difficult. "The law makes it easier for women, who previously had the issue of having to have their partner's signature. It was complicated, there were women who didn't have partners, but also who didn't want to get pregnant. So, this was really a factor limiting access", he explains. According to her, as the municipality did not change the care protocol, the growth in surgeries is directly related to changes in legislation. Mirian assesses that the increase in demand is part of a movement to strengthen reproductive planning among women. "We see a significant increase in the use of contraceptive methods. It's not just tubal ligation. Women are more dominant in deciding when they want to have children or if they want to have more children," he says. She emphasizes, however, that the medical team prioritizes offering reversible methods, such as IUDs and contraceptive implants, especially for younger patients, as reproductive intentions can change throughout life. Professor at the Department of Tocogynecology at the Faculty of Medical Sciences at Unicamp, Fernanda Garanhani de Castro Surita points out that the high number of tubal ligations reflects a historical inequality in the division of responsibilities for contraception. "In a sexist society like ours, vasectomy is often not performed due to non-acceptance of the procedure by some men, who leave the responsibility and risks of the couple's reproductive planning to the woman." For the researcher, the responsibility for contraception, the consequences of an unplanned pregnancy and even raising children still represents a female burden. At the same time, it reinforces that the decision about sterilization must be individual, free from pressure and based on information. "The new legislation is an advance, as it eliminated the need for another person to authorize the performance of a surgical procedure that concerns another person's desire and body." How to access tubal ligation and vasectomy through the SUS in Campinas Law that does not require spouse approval for tubal ligation and vasectomy comes into force Voluntary sterilization surgeries, tubal ligation and vasectomy are part of the Municipal Family Planning Protocol of the Municipal Health Department and are offered free of charge by the SUS. Access begins at the reference health center, where the woman, man or couple is welcomed by the nursing team and referred to the Family Planning Educational Group. In the group, the reversible contraceptive methods available online, the risks of surgery and the difficulties of reversal are presented. Once the decision is maintained, it is scheduled