Black women are the main victims of eclampsia and maternal mortality, research points out

A survey carried out by the IEPS (Institute of Studies for Health Policies) and the Çarê Institute shows that black and brown women are the ones who suffer most from severe pre-eclampsia and eclampsia. Black women are also the main victims of the main causes of maternal mortality in Brazil.

From January 2014 to December 2021, for every 1,000 women in labor in the country, 28.4 had eclampsia or pre-eclampsia. For white women, this rate was 24.9, while for brown women it was 27.5 and for black women it was 32.8.

In 2014, the rate of these two obstetric complications for all pregnant women was 25.2, against 33.3 in 2021. For black women, however, it went from 30.5 to 41.3.

The two other main intercurrences –severe hemorrhage and severe sepsis– were also analyzed, but did not present such expressive differentiation. In the case of hemorrhage, the average in the period was 9.1 for black women, 9.5 for white women and 10.6 for brown women. Regarding sepsis, the average was 6.6 among white puerperal women, 7.6 among black women and 9.0 considering brown women.

Health economics researcher and author of the work alongside Gisele Campos, Rony Coelho points out that, to a large extent, these intercurrences are preventable through adequate prenatal care and quality care.

This is not, however, what is observed, according to epidemiologist Emanuelle Góes, author of a study that shows disparities in women’s care.

Published in the journal Ciência & Saúde Coletiva, Góes’ research indicates that the lethality due to Covid-19 among black and brown pregnant and postpartum women was higher than that observed among white women. It also indicates that black pregnant women had less access to the ICU and that the chance of maternal death in the postpartum period for black women was 62% higher compared to white women.

“We have an issue that needs to be recognized, which is institutional racism. It interferes in the care process, in the decision-making of professionals and even of women themselves. They experience various institutional violence, either individually or collectively, knowing that their mother, her sister and her neighbor have a story of violence to tell, and this slows down the demand for the service”, analyzes .

Góes mentions previous studies that indicate, for example, that black women are less touched by health professionals and that their blood pressure is measured less frequently, which impacts the control of hypertension and the prevention of pre-eclampsia. The uterine height of black women is also measured less often, prenatal consultations are shorter and the time to be seen is longer, according to the researcher, who is part of the thematic group Racism and Health of the Associação Brasileira de Saúde Coletiva.

Added to this, many black and indigenous women live in places far from medium and high complexity services, without access to ICUs. “We have a set of factors permeated by racism that leads to the outcome of maternal mortality. They are black and indigenous people who live in these segregated places, without access to services. Racism generates this segregation”, says Góes.

The study by the IEPS and the Çarê Institute, based on data provided by the Ministry of Health, indicates that black women have the worst indicators when considering the most frequent causes of maternal mortality in the country between 2014 and 2021.

They are the main victims of complications related to childbirth and the puerperium, as well as obstetric conditions such as viral diseases, infectious and parasitic diseases, anemia, nervous system and circulatory system diseases that complicate pregnancy, childbirth and the postpartum period.

“The literature aggregates the most serious intercurrences and causes of mortality, while in our work we unravel the various types”, compares Coelho.

“Studies also point out that there is a difference between whites and blacks in maternal mortality, but we did not expect it to be so blatant and so consistent over time”, says the researcher, for whom the persistence of inequality reaffirms the discourse of activists who for years they have warned against racism in health.

For Góes, confronting institutional racism involves respecting the National Policy for the Comprehensive Health of the Black Population, which advocates the fight against the high mortality rates of this population. “We need the policy to be implemented in the three spheres, national, state and municipal, to cover everything from primary care, where women receive prenatal care, to medium and high complexity hospitals”.

“Both the black population policy and the National Policy for Integral Attention to Women’s Health are strong, concrete and well-designed. What we need is for them to be implemented”, evaluates the scientist.

On the other hand, she argues that it is necessary to invest in anti-racist training for health professionals, whether they have already graduated or are still in the beginning of training.

“Qotas allow not only bringing young black people into the health area, but encourage the reformulation of bibliographic references, of narratives. We have lived for a long time in a model that subjugates black bodies, which believes that they should be used as guinea pigs, and now we trying to build something different. It is from this place that it is necessary to build a new medicine, a new nursing, a new way of dealing with people in practice, care and science”.