Access to prenatal care is worse for black and indigenous girls, says a UFBA researcher

Racism in Brazilian society begins to affect black and indigenous people even before they are born. According to preliminary data from a survey conducted by Dandara de Oliveira Ramos, from the Collective Health Institute of the Federal University of Bahia (UFBA), skin color interferes not only with access to prenatal exams, but also with the type of delivery performed. by doctors.

While 64% of white girls have adequate access to prenatal care, this rate drops to 50% among black girls and 30% for indigenous girls, according to preliminary data from the survey on teenage pregnancy and motherhood coordinated by Ramos.

“In addition to prenatal care, the indicators of obstetric violence for the black and indigenous population are extremely high”, he says.

Ramos has been a professor at UFBA since 2019 and is also participating in three other surveys on poverty and child health in the country.

Does the study of pregnancy and maternity in adolescence, which is in progress, already have some data on the effect of race and social class on the incidence of maternity and infant mortality? Our first challenge is to look at motherhood and, initially, what we are already exploring is precisely the issue of racial inequality. Access to health care is very unequal: indigenous and black girls have the worst access to both reproductive health and prenatal care, and the scenario is very worrying. When we look at the total number of births between 2008 and 2019, we see a downward trend in the number of babies born to white and Asian girls, from 16% in 2008, to 9% in 2019, while for black girls there is a reduction of only 3% and, for the indigenous people, there is no reduction at all, on the contrary, there is an increase.

The percentage of girls without any prenatal consultation among black and indigenous girls compared to white ones is frightening: 64% of adolescent white girls have access to prenatal care; for black girls, this rate drops to 50% and, for indigenous girls, 30%. In addition, there is an excessive indication of unnecessary cesarean section, which is also reflected in the different races. In relation to child health, one of our goals is to study birth outcomes, but for now we are evaluating the incidence of motherhood itself.

Are there data today on early pregnancy and sexual violence? The study of teenage pregnancy has several ramifications; the first is to trace the impacts of public policies on these indicators, whether there was an increase or decrease in adolescent mothers from 2008 to 2019 — and here we are not talking about girls who became pregnant and had an abortion, but who had completed their pregnancy. In addition, we also evaluated the sexual violence suffered by these girls, as there is a direct relationship between violence in this age group and early motherhood.

What does your research say about cesarean inequality in Brazil? Cesarean section in Brazil is so present, the indication is so high for the entire population that it is difficult to perceive the effects of inequality in this procedure. But, apart from this more macro look, there is no doubt that the indicators of obstetric violence for the black and indigenous population are high. We have data that show that, for the black population, even if the woman already has high dilation, she has already lost fluid, the baby is in an appropriate position, the process for an attempt at normal birth is not started, and the doctors prefer to go straight to cesarean delivery.

Furthermore, the violence also occurs in the other direction. Contextualizing the late 1980s, which was when I was born, my case was symbolic: I was born with more than ten months of pregnancy because even with my mother in severe pain, the doctor said “you with a waist like that, a hip that size, she can deliver vaginally” and indicated that she should return home. At that time there was still no such epidemic of cesarean sections in Brazil, but there is also resistance to recommending the procedure when it was necessary. So prejudice, this belief that black women bear more pain, it is very ingrained in the history of gynecology, when black women were used as guinea pigs.

You became a professor at UFBA at a very young age. How was your academic trajectory and what barriers did you face? I was literate very early, still at home, and skipped a few grades of formal education, so I started university when I was 15 years old. I joined UERJ through the racial quota system and graduated at 20 years old. Throughout my journey, I was interested in issues related to poverty and violence among young people who lived in the favelas of Rocinha and Vigário Geral —where I myself lived for a while—, and I was always instigated by how the environment influences psychological and mental development. and children’s health. The main obstacles have always been linked to access to education, and in this context UERJ’s affirmative policies were very important.

Have you experienced any episode of racial discrimination or harassment at university? Harassment, no, but the experiences in the academic environment were always strained by racial expectations, as I was the only black woman in the spaces. Upon arriving in Salvador, this experience of being the only black woman changed a little, but even so, in my department it’s just me and another teacher, and that in a city with the largest black population outside of Africa. So, even when we are not a minority population, we always have the experience of being the academic and intellectual minority, seen as an exception, we do not have the same visibility as our colleagues.

Despite the recent growth of black students and professors in Brazilian universities, do you think it is still unbalanced? For sure. In the teaching career, affirmative policies still move very slowly. When I took the contest at UFBA, I applied for quotas, but I ended up passing in first place and I didn’t need to use the system. However, as I applied for a quota, I passed in May and only took office in November, while other approved colleagues took office immediately. In this period of almost six months I had to give up research grants. As much as access is being facilitated, implementation is still very fragile.

When evaluating public health policies, what are the main effects on the black population?

The indices are very uneven, despite advances in research on the health of the black population, inequalities persist at all levels. The Covid pandemic opened up these new data challenges because until August 2020 it was not mandatory to report the race or skin color of those admitted with Covid. The maternity and infant mortality indicators show that the risk of death in childhood is three to four times higher for black children compared to white children, and this is even when we adjust for socioeconomic indicators.

The road is long, and it often seems that we have gone back to square one given the violent dismantling of the current government in relation to policies to protect the black population. This moment has been one of intense work of research and militancy so as not to retreat in relation to the health indicators of the black population.

X-ray

Dandara de Oliveira Ramos, 33

Psychologist graduated at UERJ, with a master’s degree in social psychology, a doctorate in collective health from the same institution and post-doctorate at Fiocruz Bahia, with a sandwich period at McMaster University, in Canada. She has been a professor at the UFBA Collective Health Institute since 2019.