The concept may be new, but the practice is old. Obstetric racism is characterized by differences in treatment that black women undergo during prenatal care, childbirth, during the puerperium or abortion care. At the moment of greatest vulnerability, they end up suffering from oppressive, discriminatory or violent speeches or actions in reference to their ethnicity. As a consequence, mother and baby end up exposed to negative outcomes.
In early 2022, the case of a young woman from Aparecida de Goiânia, in Goiás, gained national repercussions. Ayah Akili, 25, denounced on social media having suffered violence and obstetric racism in a maternity hospital in the city, after losing her daughter at 33 weeks of pregnancy.
At the time, Ayah said that the differences in treatment began during prenatal care. Some basic pregnancy tests, such as the blood glucose curve and pre-eclampsia, were never requested. An ultrasound scan performed in the eighth month of pregnancy confirmed that the baby no longer had a heartbeat.
A study carried out by researchers from the Center for Integration of Data and Knowledge for Health (Cidacs/Fiocruz Bahia) shows that more black pregnant women died after being infected by the coronavirus during the Covid-19 pandemic, compared to white women.
“Obstetric racism influences the decision-making of health professionals and, with that, hierarchizes people and dehumanizes black and brown women at the time of prenatal care, childbirth, abortion and the puerperium”, says the study, adding that, “in contexts like the Covid-19 pandemic, these situations are aggravated and the decisions about who should receive the best conduct in care are based on anti-black racism, on the biopolitics of letting live, letting die”.
obstetric racism
In the 19th century, the American physician James Marion Sims, considered the “father of modern gynecology”, performed experimental surgeries on enslaved black women without anesthesia. The doctor believed that they endured more pain because they had “wide hips, good for giving birth”, say historians. More than 200 years later, the accounts continue.
“The manifestation of racism carries a historical legacy of violence, torture and experiments on the bodies of black women – such as the performance of procedures without anesthesia, attention or care, because they were and are considered more resistant, in the colonized reading of humanity”, states the researcher Emanuelle Góes, from Cidacs/Fiocruz Bahia.
According to Emanuelle, the vulnerability of the moment of childbirth can make it difficult for women to make decisions. “Birth is a delicate moment. This is when unnecessary interventions or lack of medical care at the right time to have a positive outcome can happen. It is very difficult, in such a vulnerable context, for a woman to identify and manage to file a complaint at that moment”, she explains.
The article Anti-Black Racism and Maternal Death by Covid-19: What Did We See in the Pandemic?, by Cidacs/Fiocruz Bahia, was published in the magazine Science & Collective Health. Researchers Emanuelle Góes, Andrea Ferreira and Dandara Ramos show that the pandemic has worsened the maternal death ratio (MMR) in Brazil, with more victims among black and brown pregnant women.
They had more severe symptoms of the disease during the puerperium, accumulated more risk factors and were the main fatal victims. Compared to white women, there were 14.02% more death records, particularly in the puerperium.
The survey analyzed 10,745 positive cases of Covid-19 in pregnant and postpartum women, registered in the Severe Acute Respiratory Syndrome database between 2021 and 2022. The report provides information on race/color, age, region of the country, clinical signs and symptoms, number of admissions to the intensive care unit (ICU) and deaths. It was found that black and brown pregnant women are the ones who least accessed the ICU.
Primer
This month, activist and councilwoman Thais Ferreira (PSol-RJ) launched the Small Manual against Obstetric Anti-Racism, inspired by the work of philosopher Djamila Ribeiro: Little Anti-Rascist Manual. The booklet, aimed at pregnant women and their families, aims to help combat violence against black women.
“Unfortunately, black women are victims of racism even in the breastfeeding process. We need to repudiate racist and lying statements in health care”, says Thais.
warning signs
Obstetric racism can occur in different situations during prenatal consultations, childbirth, the postpartum period or abortion care. The booklet provides some examples of recurrent attitudes in these situations:
Prenatal
- Queries faster than average;
- Not performing or requesting prenatal exams;
- Lack of important information for pregnant women, such as childbirth and breastfeeding, for example;
- Lower number of prenatal consultations;
- Discourage the presence of a companion in consultations;
- Not providing the pregnant woman’s booklet or keeping the material in the health unit;
- Not giving access to maternity programs, making the woman need to move to other health units.
childbirth
- Do not offer analgesia with the justification that “black women can handle pain”;
- Make cuts or sutures without local anesthesia;
- Making racist comments during childbirth;
- Neglecting care during hospitalization, with hours without evaluation;
- Perform membrane detachment or bag rupture without indication or authorization;
- Deny the pregnant woman to eat, drink water or move during labor.
Puerperium
- Neglecting the woman’s complaints of pain and discomfort during the rest period;
- Making jokes or comparisons with babies’ genitals;
- Assess the baby’s color from a white skin pattern;
- Insinuate that the woman will breastfeed easily because she is black;
- Neglect guidance and care with breastfeeding.
Complaint
Brazil still does not have a specific law for obstetric violence or racism, but the victims of these actions can report the cases in other ways, resorting to the laws of racial injury or racism. In addition, victims can file a complaint with the ombudsmen of public and private health units.
“Women should look for these spaces to denounce. The Companion Law helps a lot in this regard, with the presence of another person during childbirth, when pregnant women are very vulnerable. These individuals will help provide support and identify situations of violence,” says Emanuelle.
Federal Law No. 11,108, or the Companion’s Law, was enacted in 2005 and, since then, guarantees pregnant women the right to have a companion present during labor, delivery and the immediate postpartum period, within the scope of the Unified Health System ( SUS).
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