Note from BW of Brazil: Health, discriminatory practices and unequal access to health care are very important topics that have been featured in a number of posts on this blog. And the case that we will discuss today is a sad reminder of the severity of these issues. Past posts have delved into the death of various women, precarious childbirth situations and even miracle births. Along the way, there has been a long wait for the arrival of justice in one particular case that black Brazilian women activists have frequently written about as a glaring example of the way black women are treated in the medical establishment. From blatant acts of discrimination and disrespect, the outright human rights violations and ongoing stereotypical representations, Brazil still has a long way to go in regards to the black female population. After reading this story, you’ll be sure to agree!
One other thing…Justice was a long time coming in this case but the minuscule settlement in the case makes me question the true value of a life. It is true that life cannot be measured with a monetary figure, but as another piece recently argued, life is very cheap in Brazil!
Brazil becomes the first country to pay compensation to family as a result of a maternal death; lawsuit highlights discriminatory practices against black women in health care system
By Marcelo Brandão, Ana Rita Dutra, Eliane Brum, Cristiane Segatto, Nelito Fernandes and Isabel Clemente with contributions from Reflexão e Mudança de Atitude
The Brazilian government has agreed to pay reparations in accordance with the first decision of the United Nations for recognition of maternal mortality as a human rights violation.
Nearly three years after the Committee on the Elimination of Discrimination against Women of the United Nations (CEDAW) declared that Brazil was responsible for the death of a black woman and recommended that the State to provide access to quality maternal health services without discrimination, the Brazilian State will pay reparations to the mother of Alyne da Silva Pimentel.
According to Nancy Northup, president and CEO of the Center for Reproductive Rights:
“All women have the right to maternal health services when they need them, regardless of where they live, their salary or their race.”
“It repeatedly denied to Alyne the required medical attention, which triggered her death.”
“The Brazilian government took the first major step to complying with the UN decision, but must do more to improve maternal health services and eliminate discrimination against vulnerable women who require medical treatment.”
“The Brazilian state is taking an important step in recognizing that the health system failed Alyne and other vulnerable Brazilian women,” said Mónica Arango, regional director for Latin America and the Caribbean at the Center for Reproductive Rights. “There remains some way to go for financial reparations be paid to the daughter of Alyne and for public policies that improve maternal health services for all women without discrimination to be created.”
According to the World Health Organization, approximately 800 women die every day worldwide from complications associated with pregnancy. A quarter of all maternal deaths in Latin America occurs in Brazil and ninety percent of them could be prevented by prenatal care. Although Brazil has reduced its maternal mortality rate in the last decade, maternal mortality remains the major cause of deaths among women of reproductive age, affecting disproportionately women with scarce resources, black, indigenous and those living in areas in rural northern and northeastern regions of Brazil.
Alyne Silva Pimentel, a 28 year old black woman and resident of the Baixada Fluminense region of Rio de Janeiro died on November 16, 2002, in the sixth month of pregnancy, five days after being admitted to a public hospital with signs of a high risk pregnancy and lack of appropriate care. Alyne left a five year old daughter at the time and her death could have been avoided if she had had access to basic obstetric quality care, which is the responsibility of the Brazilian State, as defined by the Constitution of 1988.
On August 10, 2011, the Comitê pela Eliminação de Todas as Formas de Discriminação contra a Mulher (CEDAW or Committee on the Elimination of All Forms of Discrimination against Women, of the UN, condemned Brazil in the Alyne da Silva Pimentel case. The decision of the UN CEDAW Committee concluded that the Brazilian state failed to protect the human rights of Alyne to life, health, equality and non-discrimination in access to health care. The Committee also considered that the State failed to guarantee Alyne’s family effective access to justice.
The indemnity payment owed to Alyne’s mother is an important step that needs to be accompanied by other measures of reparation and non-repetition as the implementation of health policies that guarantee physical integrity, life and health of women and which are effective to avoid similar cases.
At the time of her death, Alyne left behind a 5-year old daughter
Text from 2008 report by Eliane Brum, Cristiane Segatto, Nelito Fernandes and Isabel Clemente
When her mother didn’t come home, Alice had many questions. “Where is my mother? Where is the baby? Why didn’t my mother back?” After hearing the answers, she stopped talking. She tried but couldn’t. When she could, she stammered. With Alice it was like this: first she lost her mother, then the words; and at only had five years of age. Another five passed. And Alice lost more; a year of school because he didn’t speak right. Her father constructed a new family and hardly saw her. Her grandmother got sick and can’t work as a domestic. Last year, another daughter died, she went on to raise another grandchild. Who sustains it all is the 77 year old great-grandmother. Alice is now 10. And a life that words can no longer describe.
Alice da Silva Pimentel, a girl with sad eyes from Belford Roxo in the Baixada Fluminense region, is at the center of an international trial. At the defendant stand is the Brazilian State. The death of her mother, Alyne, was brought to the Committee of the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), the UN. Brazil is the first country in the world to be judged by a case of maternal death. It has until July 16 to explain why it let Alice’s mother die at the age of 28 and six months pregnant. It is a moral and political judgment that in diplomacy is called “the power of embarrassment.”
This is a timeline of Alyne’s last five days of life
• November 11, 2002 – Alyne felt sick. Accompanied by her mother, Maria de Lourdes, she went to the Casa de Saúde Nossa Senhora da Glória (Our Lady of Glory House of Health) in Belford Roxo in Baixada Fluminense. She left with a prescription for nausea, vitamin B12 and a topical medication for vaginal infection.
• November 13 – Alyne worsened. She returned to the health center. She was received by the doctor responsible for her prenatal care. “He told my daughter: ‘Since you say you feel so bad, I will admit you’” said Maria de Lourdes. “I even asked if the baby was okay, he said it was.” In maternity, Alyne was tended to by a third party professional. An ultrasound showed that the fetus was dead. Childbirth was induced. At 7.55pm Alyne gave birth to a stillborn fetus of 27 weeks.
• November 14 – the doctors did surgery to remove the placenta only 14 hours after the stillbirth. Soon afterward, Alyne was bleeding, vomiting blood, and her blood pressure dropped. “I called several times to the hospital. They told me she was fine and could be discharged the next day,” says Maria de Lourdes.
• November 15 – Alyne continued hemorrhaging and could not breathe. “The doctor said that my daughter was in danger of death. She explained what had happened, but I didn’t understand, because there were some big words,” said Maria de Lourdes. Alyne decided to transfer. The only one that accepted her was the Hospital Geral de Nova Iguaçu (General Hospital in Nova Iguaçu). Alyne waited for an ambulance for eight hours. She only arrived at the hospital at 9:45pm without her medical records. She was in a coma. There was no bed. Alyne went to the emergency room.
• November 16 – Alyne died at 7pm. According to the autopsy, the cause of death was “gastrointestinal bleeding.” Alyne was 28. Married to Adriano, a general services assistant, she helped the family income by selling jewelry. An Evangelical, she was the main voice of the church choir. She dreamed “big”, as her mother says: she wanted to visit Venice and send her daughter Alice to college.
Statistics show that all Brazilian women are vulnerable to childbirth complications. Every year more than 4,000 Brazilian women die from issues connected to pregnancy, but for black women the situation is far worse. According to a 2009 report, the relative risk of maternal deaths for black women is 7.4 times higher than that of non-black women, literacy rates and education are 90% and 83% for white women, against 78% and 76 % for black women, respectively. Of households headed by black women, 60% have incomes below the minimum monthly salaries. Black women are the greatest victims of the lack of care in SUS health care system (1) in the event of legal abortion.
Like other experts who have spoken on this issue, Maria Luisa de Oliveira also points out the racial inequalities in the health care system. She is a psychologist, with a Master’s in Public Health and Specialist in Ethics, Education and Human Rights. She is a militant of the black women’s movement. Currently working in Sempre Mulher Instituto de Pesquisa e Intervenção sobre Relações Raciais (Forever Woman Institute for Research and Intervention on Race Relations), an affiliate of the Rede Feminista de Saúde (Feminist Health Network), and represents this network is the Plataforma DHESCA Brasil (DHESCA Platform Brazil). In a 2013 conversation with Ana Rita Dutra, she touched upon this question of medical attention given to black women.
What are the main problems faced by black women in health care today?
I’d say the main problem remains the operation of institutional racism that determines that black women receive unequal treatment at the time of health care. Let me explain: the prejudices, preconceived and disseminated ideas in society about black women are interjected so that professional assistance in health start to see the black population through these filters, so that the treatment is not the same for all women. Examples: for a long time, black health activists have denounced that black women receive less analgesia in childbirth due to the belief that we are more resistant to pain or that we should go through suffering because we make children indiscriminately, without being able to raise them, we are factories of the little marginalized, etc., etc., etc. We also know that black women, even going to consultation in health facilities, do not have breast examinations, which is vital for early detection of breast cancer. Another side of the problem is that diseases prevalent in the black population as a whole and in black women in particular are not sufficiently studied and understood, hampering assistance. Today, not so much, but a few decades ago black women were sterilized because of uterine fibroids, coupled with sterilization as a form of birth control and extermination of our population.
Government compensates Alyne’s family
The Ministra da Secretaria de Direitos Humanos da Presidência da República (Minister of the Secretariat of Human Rights of the Presidency of the Republic), Maria do Rosário, in addition to ministers of the Secretaria Especial de Promoção da Igualdade Racial (Special Secretariat for the Promotion of Racial Equality), Luiza Bairros, and the Secretariat of Policies for Women, Eleonora Menicucci, presented Alyne’s mother, Maria de Lourdes Pimentel, a certificate that recognizes the state’s responsibility in her daughter’s death and the financial reparations because of what happened.
“The death of your daughter is seen by us as a responsibility of public service. She died because the service was not suited to her needs. I mean that it deals with reparation of a symbolic character, to assume in front of the Brazilian people and the international community the responsibility of the Brazilian government in the death of your daughter,” said Maria do Rosário to Alyne’s mother.
The government paid to Maria of Lourdes US$55,000 (dollars), worth about R$131,000 (reais), in financial compensation for the death of Alyne. Moreover, the three ministers on behalf of the federal government, pledged to work for the reduction of maternal deaths. Measures, according to the representative of the Ministry of Health at the event, Dário Pasche, are already being taken by the Programa Rede Cegonha.
The Minister Maria do Rosário further explained the reason for the delay in payment of compensation to the family of Alyne. “The delay was because we had to structure the payment system so that it was legal. We had to have a judgment which established the legality of values and recommendation, as it is an international recommendation which was incorporated into domestic legislation.”
The victim’s mother sought CEDAW that in 2011 found the Brazilian government responsible for what happened and condemned it to pay compensation to Alyne’s family. The process, according to Rosário, serves as a parameter for similar cases.
1. The Sistema Único de Saúde or Unified Health System), better known by the acronym SUS, is Brazil’s publicly funded health care system. SUS was created after the Brazilian Constitution of 1988, which assured that health care is a “right of all and an obligation of the State”. Prior to that, only people who contributed with the social security were able to receive health care. The creation of SUS was important in the sense that more than 80% of the Brazilian population depend on it to receive medical treatment. Brazil provides two-tier health care, but almost 25% of the population pay for private insurance. Source