Over the past ten years, health care has been municipalized in the northeastern state of Ceara, Brazil. Municipalities now provide basic health services which were formerly the responsibility of the state government. Although this policy was mandated by the Federal Constitution of 1988, Ceara is one of the few states that has complied with the law. This occurrence combined with the state's past dedication and innovation in the area of health offers a unique opportunity to examine the impact of decentralization on the specific case of women's reproductive health services. Ceara has given political and financial support to improving reproductive services. Political commitment, along with a strong civil society organization, creative health professionals, and the dedication of local officials has provided a climate of change and true, albeit minimal, improvement in women's reproductive health services.