Note from BW of Brazil: In Brazil, there are certain realities that must be dealt with regardless of how uncomfortable the facts make people feel. For example, it is a fact that Brazil is a very violent country. But it is also a fact that this violence disproportionately affects the Afro-Brazilian population. In terms of racial diversity, Brazil is one of the most diverse countries in the world. But it is also a fact that we rarely see this diversity in the nation’s mainstream media. Another fact is that the nation lacks the medical infrastructure to serve its population of 204 million people adequately and equally. Which is one of the reasons the government implemented a program to attract doctors from Cuba to address the shortage of qualified physicians. And yet another fact is that during pregnancy, black women are at more risk to suffer complications due to their race and medical negligence. As such, one could say that racism in Brazil in fact begins during pregnancy and continues throughout the life of those who are considered Afro-Brazilian. These facts and experiences are the topic of our ongoing series of reports on health care inequality in Brazil.
Racism begins at pregnancy
A series of reports addresses the reality of pregnant black women, the main victims of obstetric violence in the state
By Renata Coutinho
Maternal mortality among preta (black) and parda (brown) women is seven times greater than in white women, with 70.5% of all registered
Brazilians historically neglected. Even the majority in several indicators, such as populational and those who point to the need for certain types of assistance, blacks continue to suffer to achieve basic rights. In health, the lack of preparation of professionals and institutional racism lead pregnant women to really suffer from the waiting room to the operating table. In schools, children and adolescents are faced with the lack of acceptance of their culture, their religion and their hair, which has culminated in alarming dropout rates. In the labor market, more barriers are imposed by veiled prejudice: lower wages and the sentence of only occupying spaces for those with less qualification. In the series Questão de Pele (Issues of Skin), published from today until Tuesday, the Folha de Pernambuco shows stories of people who witnessed early on the effects of racial inequalities and who made of their lives a banner to fight against discrimination. Texts are by Luiz Filipe Freire, Renata Coutinho and Tatiana Notaro. Photos and video by Leo Motta.
Coupled with discrimination of sex, race produces adverse effects on the health of pregnant black women. Racism results in obstetric violence, death and pain. And exposes the “lack of assistance of color”. The maternal mortality among them is seven times higher than in white women. In the state, 70.5% of gestational deaths were of pretas and pardas according to data from the research “Nascer no Brasil” (Born in Brazil), the largest national survey about labor and birth, held in 2013. The causes of loss of life are varied, but reflect a historical neglect of prevalent diseases in this population, such as sickle cell anemia, hypertension and diabetes II. They denounce institutionalized prejudice in health.
The study revealed that 25% of them have at risk pregnancies, but they couldn’t get medical care at a referral center. Vaginal delivery is undergone by more than 60% of black women. The presence of accompaniment during the process is low, 16%. Privacy during labor, clarity of explanations and participation in decisions about birth is almost nonexistent.
“Prejudice is blatant and begins prenatally. The racist ideology doesn’t care about the specifics of the black woman,” attests the representative of the Comitê Técnico da Saúde da População Negra (Technical Committee of the Health of the Black Population) connected to the Ministério da Saúde (Ministry of Health or MS) and member of the Articulação de Mulheres Negras Brasileiras (Articulation of Black Brazilians Women), Vera Baroni, who reports: Although the MS advocates conducting at least seven visits before delivery, 33% of black women make just one to five visits.
Another question she points out as serious is the failure to achieve a hemoglobin electrophoresis test – she identifies sickle cell anemia and care for the pregnant woman should be expanded, if the disease is identified. “It’s obligatory. But it’s not done. In Pernambuco, for example, only the cities of Recife and Olinda make the examination in prenatal. However it is still necessary that the physician requests it. And often the professional thinks it’s unnecessary.” For Vera Barroni, there is a general negligence, even of public officials in enforcing the National Policy on Comprehensive Health of the Black Population.
The coordinator of the Política de Saúde da População Negra (Health Policy for the Black Population) of Recife, Sony Santos, makes the same assessment of the scenario. But she argues that local governments have worked to stop racism. “Our orientation is that the professional already requests the electrophoresis certification exam on the first visit and keeps an attentive look at the specifics of race. It is our challenge, as well as several cities, to combat unequal treatment that leaves the black woman in a vulnerable situation,” she confirmed.
Teacher Lindacy Assis, 46, knows this whole scenario up close. “Institutional racism is perverse. It is within medicine, which is white. Where there is no prospect of working with questions of gender and race,” she noted. A carrier of sickle cell anemia – a hereditary and genetic blood disease that alters red blood cells – Lindacy knew the risks that a pregnancy in her condition would bring. So she was stunned when she discovered she was pregnant at 22.
Successive threats of abortion, crises of pain and ignorance of doctors about taking care of a pregnant woman with sickle cell occurs throughout the entire pregnancy. “We feel a lack of specialists. I understand that it’s precisely because of racism. Because the disease is prevalent in the black population,” she said. During childbirth neglect remained. She spent more than 12 hours with her water broken, being forced by professionals to have a vaginal delivery when the recommendation for a patient in her condition would be a C-section.
“It’s historic and cultural discrimination of that by being black a woman can handle pain. So between doing a cesarean section on a white woman and a black woman, we’re put to the side. That’s what happened to me,” she recalled. The teacher went on to look into the health of black woman with sickle cell, is an activist in the Movimento Negro (black movement) and is writing a book that will earn the name Mulheres de Foice (Women of Sickle).
Wheezing, difficulty standing and dizziness. Severe pain due to a necrosis in the femur. This is how we find Vanessa Ferreira, 29, pregnant with twins and having sickle cell. She is in her second pregnancy. In the first a vaginal delivery was attempted until the last moment, when in an emergency she was operated on. “I had no strength. I didn’t have admission and thought I was going to die. The doctor didn’t even know that I had sickle cell disease, until my mother insisted. Health (care) often times is not prepared to receive a black woman,” she said.