If a black woman and a white woman both need emergency obstetric care, the Brazilian physician will choose the white woman because of the idea that “black women are more resistant to pain and are accustomed to giving birth.” Brazilian social and cultural conventions “attribute to blacks conditions of stereotypes, that cause them to not get the same degree of health treatment as whites,” said psychologist Crisfanny Souza Soares, of the Rede Nacional de Controle Social e Saúde da População Negra (National Network of Social Control and Health of the Black Population). These stereotypes reflect a racism that is harmful to health and that a campaign is trying to eradicate from the Brazilian hospital system.
Of the 192 million Brazilians, half recognize themselves as black. The Mobilização Nacional Pró-Saúde da População Negra (Pro-Health National Mobilization of the Black Population), was launched this year by Afro-Brazilian organizations, with support from the United Nations Population Fund (UNFPA). Under the motto “Vida longa, com saúde e sem racismo (Long, healthy life and without racism),” the aim of the campaign is full health at all stages of life, encouraging the society, and in particular the health system, to combat discrimination to reduce the high rates of mortality of the population of African origin.
“Virtually all the health indices of black women are worse than those of white women. In a consultation about breast cancer, black women are less thoroughly examined than white women, and receive less anesthesia in childbirth,” says Crisfanny. The Ministry of Health, that since 2006 has driven a comprehensive national policy for this population group in the context of the Sistema Único de Saúde (SUS or Unified Health System), conducts studies to detect this type of situation.
“The idea that the black population is more resistant to pain and is better able to cope with disease is present throughout the health system, from the nursing staff to the doctors,” said Deise Queiroz coordinator of the Articulação de Jovens Negras (Articulation of Black Youth) in Bahia. She knows this well, especially because her mother, who suffers from diabetes and high blood pressure, often must resort to the public health system. According to the activist, SUS, which was a model of democratization of health services, today so cannot meet demand, and “racist attitudes become more evident.”
The researcher Eliane Barbosa da Conceição of the Fundação Getulio Vargas (Getulio Vargas Foundation) remembers a study done with doctors about the basic care of black women during childbirth:
“The responses that the doctors had when asked about basic care given to black women during childbirth were that they (black women) were stronger, had thicker blood, that we blacks have stronger teeth, that we black women are more resistant than white women. So, it wasn’t the logic given by them (the doctors) but it is the logic of the research.”
The Constitution states that health is a universal right and the state has a duty to provide it. SUS provides that “all persons are entitled to humane treatment and quality without any discrimination.” However, racism infiltrates openly or subtly. “It incorporates itself in the living conditions of the population, the organization of health services and policy formulation,” said UNFPA representative in Brazil, Fernanda Lopes. “Because of this it is necessary to build specific policies of equity,” she said.
An epidemiological study of the Ministry of Health provides specific information to help fill in these gaps by comparing indicators such as prenatal care by race, color and ethnicity. It also examines other aspects, such as the right and access to family planning, which is among the most precarious amongst African descendants. It is precisely this aspect that is the center of the UNFPA global report, submitted on November 14th, with the title Sim à Opção, não ao Acaso – Planejamento da Família, Direitos Humanos e Desenvolvimento (By Choice, Not by Chance – Family Planning, Human Rights and Development.
For example, 19% of children born alive to teenage mothers are white between 15 and 19 years of age. However, the incidence of teenage pregnancy is 29% among young Afro-Brazilian women in the same age group. Furthermore, while 62% of mothers of white children say they have made seven or more prenatal consultations, only 37% of newborn children of mulattos and blacks had this number of consultations before delivery.
Infant mortality also shows disparities. The risk of a black or mulatto child dying before the age of five by infectious and parasitic diseases is 60% higher in relation to a white child. And death from malnutrition is 90% higher. The study also found that more pregnant African descendant mothers die than white pregnant women from causes related to pregnancy, such as hypertension.
“They say that the worst health indices of the black population are due to the fact that most are poor and therefore more vulnerable,” noted Crisfanny. However, one cannot deny other strictly racist variables, she warned. “If a hospital sees two young people who have been shot, it is easier in the cultural imagination to put the white in the role of victim, while the black would be there because there he was involved in a crime,” assessed the psychologist, affirming that sometimes this reference “causes a professional to establish priorities in treatment.”
Another concern relates to diseases prevalent in people of African descent, such as sickle cell anemia, diabetes mellitus type II and hypertension, that the health system is not prepared to address in a specific way. Black women are 50% more likely to develop this type of diabetes, with the aggravation of hypertension among them being two times higher than in the general population.
The same occurs with sickle cell anemia, which could be detected in newborns. According to Pro-Health National Mobilization, about 3,500 Brazilian children are born each year with this disease, making it the highest incidence of genetic disease in the country. “The black population dies, in general, sooner, and their deaths from preventable causes are more frequent,” Fernanda pointed out. Therefore, a policy to combat discrimination in health “should minimize the impact of historical inequities through strategies of affirmative action,” she added.
UNFPA contributes with the government and the Movimento Negro (black civil rights movement) to strengthen the policy and training that should accompany it. “The challenge is to answer why, in a country where the black population represents 50.3% of the total, we have a picture of health so differentiated” between blacks and whites, the Ministry of Health admitted.
Source: Envolverde, TVT
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