In many countries, clientelist parties (or political machines) distribute selective benefits in contingent exchange for political support. Studies of clientelism should distinguish between substantively different patterns of machine politics. A fundamental but often overlooked distinction lies between “electoral clientelism” and what I term “relational clientelism.” Electoral clientelism delivers all payoffs to citizens before voting, and involves the threat of opportunistic defection by citizens. By contrast, relational clientelism continues to deliver benefits to citizens after voting, and involves the threat of opportunistic defection by both citizens and politicians. Building on fieldwork and regression analysis, this study explores these distinct patterns of clientelism in the context of healthcare and female sterilization in Brazil.