Note from BW of Brazil: The health of black population is a theme that has been at the forefront of many demands of Afro-Brazilian organizations for a number of years. These demands stem from a number of unfortunate incidents that happened to black women that could have been avoided. We’ve seen Brazil become the first country to pay compensation as a result of a maternal death. We’ve seen black women die as a result of dangerous, clandestine abortion attempts and we have them lose babies due to medical neglect. Unfortunately all too common occurrences. We also see that Afro-Brazilian women are more likely to die due to childbirth related complications than non-black women. These serious problems are often linked to what activists see as discriminatory treatment of black women and racial stereotypes in medical establishments.
This is not to say that all problems are directly linked to racism, but the question of how someone would have been treated had they been white cannot be ignored. And while the medical establishment continuously ignores or downplays the possibility, stories like that of the then 17-year old Josiane Nunes (photo above) continue to add up. In 2012, an eight-month pregnant Nunes, a resident of Fundão in the greater Vitória region of the state of Espírito Santo, carried a dead fetus in her womb for almost three weeks. In a fifteen day period, the young woman went to six different cities, but even with a drop in blood pressure and spells of dizziness, doctors never performed a surgery. Why? We continue our ongoing coverage of the issue below.
Black women and health: “Invisibility sickens and kills!”
Statistics show that in Brazil, black women are deprived, in various ways, from access to health care. How do you bring visibility and combat this framework is based on racist and sexist mechanisms?
By Jarid Arraes
On 25 November, the Ministry of Health launched a campaign against racism in the Sistema Único de Saúde (SUS or Unified Health System), which generated outrage within the medical profession. In an attempt to educate the public and health professionals in respect to this racism in health care, statistics were shown, statements and images stimulating denouncements against cases of discrimination.
The Conselho Federal de Medicina (Federal Council of Medicine), however, positioned itself in the opposite way to the campaign, alleging that it contained a racist tone; the secretary of the CFM, Sidnei Ferreira affirmed that the Ministry insinuated the practice of a kind of “apartheid” on the part of physicians, in which it would give differentiated service between black and white people.
Perhaps the Secretary of the Federal Medical Council has not looked over the statistics released by the Ministry, nor interested in hearing the various collectives, NGOs and organizations fighting against racism in Brazil. If he had done any research, Sidnei Ferreira would face the undeniable reality of institutionalized racism: yes, health professionals treat black people in a different, neglectful and discriminatory manner- something that goes far beyond corporatism.
This fact is evidenced further by some numbers, which can also be seen in the official campaign page entitled “SUS sem Racismo” (SUS without Racism). In published statistics, racial and gender issues are intertwined, exposing the unfortunate situation of vulnerability in which black women find themselves. Among the exposed data, the campaign shows that black women tend to receive on average less medical care time than white women and that they make up 60% of the victims of maternal mortality in Brazil. In addition, only 27% of black women had accompaniment during childbirth in the research, as opposed to 46.2% of white women; and 62.5% of black women were oriented about the importance of breastfeeding, passed over in favor of the 77% of white women.
Additionally, there are other studies and testimonials, even on the internet, of black women who have suffered neglect and abuse undergone in hospitals due to racial discrimination, including in private clinics. There are several reports of women who were not properly anesthetized at a time when anesthesia was needed, who spent more time waiting in lines – even coming first – or didn’t receive medications and analgesics to relieve pain. In the statements, there is the constant presence of racist statements, such as the idea that black women are more resistant to pain than white women, for example.
These practices are tremendously dehumanizing and come from the slave secular logic imposed on black women. Even today, racism continues to be perpetuated in hospitals, environments so important that they should be the right of all. Fortunately, there are voices denouncing and presenting these issues, as much as through militancy as through the intellectual and career paths. Nurse Emanuelle Goes, a black woman, blogger, with a Master’s in Nursing, working on a doctorate in Saúde Pública (Public Health) (at UFBA, the Federal University of Bahia)) and an activist for the health of black women, is one of those very important voices.
An analogy between Africa and Brazil
Although temporarily stepping back to dedicate herself to her Doctorate, Goes is also a part of Instituto Odara (Odara Institute), where she works in the health field – more precisely, in social control and monitoring of health policies with a focus on gender and race. The Institute exists to address medical racial discrimination in its various nuances.
“Odara is a black feminist organization that aims to overcome discrimination and prejudice on a personal and collective level and seeks alternatives that provide the socio-political and economic inclusion of black women and their families in society,” she explains. “The Institute emerged from the specificities of being a black woman that, in Brazilian society, is structured by racism, sexism and all forms of oppression, causing a number of disadvantages, such as lower wages, less access to higher levels of education, involuntary celibacy, more responsibility of family income, higher unemployment and poverty. When articulated, they will exacerbate the exclusion of these women.”
Recently, the professional also published a blog entry “População Negra e Saúde” (Black Population and Health), which addresses the health situation of black women in Brazil, with more relevant and urgent issues to be discussed. In the article, Emanuelle Goes discusses various issues from female genital mutilation that happens in African countries to the problem of illegal abortion in Brazil, always emphasizing the racist and sexist mechanisms that practically promote genocide of black women.
Although there are cultural differences and issues specific to each country and society, Goes says that the logic is very similar, based on the same structures of sexism and racism, so we can relate the problem of female genital mutilation in African countries with violence demarcation of gender that black girls and women suffer in Brazil, for example.
In her text, the nurse uses female genital mutilation practiced in African countries to draw an analogy with the suffering of black women in Brazil and elsewhere in the world. “Female genital mutilation does not receive the attention of the world as it should, even considering that it is a violation of the right to health for the United Nations, as a human right,” he says. “It’s considered a tradition, a culture, in fact, it’s a social, economic and political convention, and the lack of attention or the invisibility of this topic is related to the population that suffers from it, which are black women in many countries of Africa. There is no such discussion in Brazil.”
A point of comparison that should yield research and debate is the issue of compulsory sterilization imposed on black women: if in some countries, such as Kenya, women with HIV or AIDS go through forced sterilization in Brazil something similar has already happened. “In Brazil, forced sterilization together with the mass sterilization was intended to reduce the populational contingent of black and poor in the country, and this also happened in other countries that practiced eugenics medicine. Here, in the 1980s, international organizations – with Brazilian government support – an incisive agenda of birth control with the use of hormonal methods [pills and injections], especially in northeastern Brazil was initiated,” she says.
According Goes, the black women’s movement is the protagonist of the fight against genocide of black people and the usurpation of the freedom of women, initiating the fight in the form of denouncement. “This fight will result in the creation of the Comissão Parlamentar Mista de Inquérito (CPI or Joint Parliamentary Committee of Inquiry), established by the Brazilian National Congress in 1991. The CPI of sterilization found that there was inadequate provision of the services offered by the private funding institutions of contraceptive methods, including the irreversible, being expanded mainly in the poorest regions of the country. But in 1996, through the recommendation of the CPI, the specific law (Law 9.263/96), which regulates access to female sterilization was approved.” For her, this process is a major milestone in the fight for the health of the black population.
The points presented by Goes are quite unknown, something that extends, unfortunately, even to the feminist groups that are still wavering on the approach to racism and the specifics of black women. In fact, the neglect suffered by black women, whether in Brazil or on the African continent, denounces the enhancement of racism with dominant sexist values in many parts of the world; above all because these facts expose the bases of discrimination currently experienced, built on the slave and ethnocentric foundation of a culture that diminishes blackness and the feminine.
The health of black Brazilian women
It’s undeniable that racial issues affect the health and quality of life of black women, going through not only situations of discrimination in hospitals, but also through the laws themselves. Among the various causes of death for black women, the illegality of abortion can be considered one of the most devastating.
Emanuelle Goes has as her PhD project the issue of abortion analyzed from a racial perspective in which she studies women in situations of abortion in the Brazilian northeast. Her main focus is the decision for abortion, access to health services and quality of service. “The legalization of abortion has a direct positive impact on black women because we are the ones subjected to unsafe abortion in greater proportion compared to white women,” she says. She emphasizes that unsafe abortion contributes substantially to maternal mortality of black women and it’s still necessary to discuss how abortion and the decision to do so is distinguished by black and white women.
Despite apparently being in extremely opposite poles of a situation, the illegality of abortion and compulsory sterilization are faces of the same sexist racism that denies the autonomy and freedom of the black woman. “The two situations are in the field of the right of choice and autonomy of women’s bodies; the patriarchal and racist society finds itself in the right to decide, because, in fact, sterilization seems to me to have the strength of racism where the unwanted, which is the black population, have to be eliminated. And abortion is patriarchalism that prevails over the decision of women’s bodies,” she explains.
For all that, it is still confusing the position of the Federal Council of Medicine, who always reiterates its favorable position to the legalization of abortion in Brazil showing that it’s dealing with a public health issue. Just as clandestine abortion, it is clear that all public health problems cause more serious and tragic consequences for black women, who lead in the worst indices and statistics in institutional research. “We have a Política de Saúde da População Negra (Health Policy for the Black Population) that is law, but we need to advance much; in other times we struggled for terms of health services, today we struggle to access it in full, fair and free from discrimination,” adds Goes.
The attempt to prevent initiatives such as the Ministry of Health campaign consists of a deliberate action of silencing, which complicates the discussion of racism and condemns thousands of people to neglect. In this regard, Goes think that there is a common axis as the health of black women that intersects like racism and sexism, that would be a great obstacle for the visibility of these women in the eyes of health. “Invisibility sickens and kills!” she adds.
The fact is that the forces against racism mustn’t be solely institutional, because racial discrimination is not only a problem in SUS. But the dirt also needs to be cleaned within the context of health professionals, for if black women are neglected and abused in hospitals, it is because there are people and organizations promoting and approving such violence.