Desigualdades raciais, sociodemográficas e na assistência ao pré-natal e ao parto, 1999-2001

Abstract

ObjectiveTo analyze social inequalities and inequalities in access to and utilization of health care services according to skin color in a representative sample of postpartum women receiving hospital childbirth care. Methods A cross-sectional study was carried out in a sample of 9,633 postpartum women, of whom 5,002 were white (51.9%), 2,796 mulatto (29.0%), and 1,835 black skin color (19.0%), seen in public maternity hospitals, hospitals contracted out by the Unified National Health System, and private hospitals in the period 1999-2001. Data were collected from medical records and through interviews with the mothers in the immediate postpartum period using standardized questionnaires. Statistical analyses were performed using χ² tests to assess homogeneity of proportions and Student's t-test for comparison of measures. The analysis was stratified by maternal schooling. Results A persistent unfavorable situation was seen for mulatto and black women as compared to white women. Mulatto and black women had the highest rates of adolescent mothers, low schooling, unpaid occupation, and not having a partner. History of physical violence, smoking, attempts to interrupt pregnancy, and visits to several hospitals before being admitted were more frequent among black women, followed by mulatto and then white women of low schooling. High schooling group of women showed better indicators but the same pattern was seen. This variability is also seen in the opposite direction in terms of the level of satisfaction with prenatal and childbirth care. Conclusions It was distinguished two forms of discrimination, by educational level and skin color, in care delivered by health services to postpartum women in Rio de Janeiro.

Fatores associados a não realização da mamografia e do exame clínico das mamas: um estudo de base populacional em Campinas, São Paulo, Brasil

“…É possível aventar que a percepção da necessidade de consulta ginecológica para problemas originados com a vida sexual ativa e para propostas de contracepção, e não a uma perspectiva mais ampla de cuidado com a saúde, levaria mulheres sem companheiro a demandarem menos os serviços ginecológi-cos e, portanto, a terem menor acesso ao exame clínico das mamas. Mas, outro estudo brasileiro identificou que as mulheres pertencentes a famílias chefiadas por homens apresentam maior chance de utilização de serviços preventivos e de acompanhamento, levantando como hipótese explicativa que restrições sociais e econômicas limitariam o consumo de serviços de saúde pelas mulheres que são chefes de família 24 .…”

Does life-course socioeconomic position influence racial inequalities in the occurrence of uterine leiomyoma? Evidence from the Pro-Saude Study

“…Alternative possible explanations include increased medical surveillance among blacks, or perhaps racial discrimination among health professionals in deciding or administering treatment 30 . For example, in some studies nonwhite women overall had lower rates of Pap smears and of anesthesia use in vaginal delivery, and a higher risk of surgical sterilization, independently of other socio-demographic characteristics 31,32,33 .…”

Diferenças socioeconômicas entre autoclassificação e heteroclassificação de cor/raça

“…Other important published studies on the attribution of color/race in Brazil notably include those by Pinto 19 (1996), Telles & Lim 23 (1998) and Guimarães 8 (1999). As examples of epidemiological studies using (in this order) self-classifi cation, interviewer-classifi cation and a combination of these two strategies for determining the color/race of participating individuals, the studies by Leal et al 14 (2005), Dias-da-Costa et al 7 (2007) and Almeida-Filho et al 1 (2005) can be cited.…”