Brazilian fertility has fallen rapidly in the last three decades, even in the Northeast, the country's poorest region. Female sterilization has become the most common contraceptive method in this region, where 44 percent of married women aged 15–49 years were sterilized as of 1996. While in other regions sterilizations were generally paid for by the patient, politicians and physicians arranged and paid for the large majority of these surgical procedures in the Northeast. The authors present evidence that this phenomenon is the result of the use of sterilization as an electoral good by politicians and physicians in local contexts where politicians regularly provide goods and services to the poor in exchange for votes. This systemic behavior seems to have been little affected by 1997 legislation that regulated family planning, made sterilization legal, and was intended to increase the use of other methods of contraception.