Barriers in Accessing Care for Consequence of Unsafe Abortion by Black Women: Evidence of Institutional Racism in Brazil

Góes, Emanuelle Freitas; Menezes, Greice Maria de Souza; Almeida, Maria da Conceição Chagas de; Barreto-de-Araújo, Thália Velho; Alves, Sandra; Alves, Maria Teresa Seabra Soares de Britto; Aquino, Estela Maria Motta Lima Leão de

doi:10.1007/s40615-020-00900-w

Cited by 10 publications

(10 citation statements)

References 36 publications

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“…31 Within the maternal–child health context, institutional racism can result in racial inequities in access and quality of prenatal and perinatal care, including access to maternal interventions including pregnancy terminations. 32 …”

Section: Discussionmentioning

confidence: 99%

“…In addition, structural racism (eg, as manifested in policies) may impose institutional barriers for non-white population groups to access resources and opportunities, resulting in lower levels of education, poorer living conditions and inadequate health care 31. Within the maternal–child health context, institutional racism can result in racial inequities in access and quality of prenatal and perinatal care, including access to maternal interventions including pregnancy terminations 32…”

Section: Discussionmentioning

confidence: 99%

“…31 Within the maternal-child health context, institutional racism can result in racial inequities in access and quality of prenatal and perinatal care, including access to maternal interventions including pregnancy terminations. 32 Previous studies have demonstrated that single women are more likely to give birth to newborns with adverse pregnancy outcomes, such as small for gestational age, when compared with married mothers. 33 Being single is increasingly recognised as a risk factor for adverse pregnancy outcomes, potentially due to a lack of social support or increased stress.…”

Section: Bmj Global Healthmentioning

confidence: 99%

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Socioeconomic risk markers of congenital Zika syndrome: a nationwide, registry-based study in Brazil

et al. 2022

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While it is well known that socioeconomic markers are associated with a higher risk of arbovirus infections, research on the relationship between socioeconomic factors and congenital Zika syndrome (CZS) remains limited. This study investigates the relationship between socioeconomic risk markers and live births with CZS in Brazil. We conducted a population-based study using data from all registered live births in Brazil (Live Births Information System) linked with the Public Health Event Record from 1 January 2015 to 31 December 2018. We used logistic regression models to estimate the OR and 95% CIs of CZS based on a three-level framework. In an analysis of 11 366 686 live births, of which 3353 had CZS, we observed that live births of self-identified black or mixed race/brown mothers (1.72 (95% CI 1.47 to 2.01) and 1.37 (95% CI 1.24 to 1.51)) were associated with a higher odds of CZS. Live births from single women compared with married women and those from women with less than 12 years of education compared with those with more than 12 years of education also had higher odds of CZS. In addition, live births following fewer prenatal care appointments had increased odds of CZS in the nationwide data. However, in the analyses conducted in the Northeast region (where the microcephaly epidemic started before the link with Zika virus was established and before preventive measures were known or disseminated), no statistical association was found between the number of prenatal care appointments and the odds of CZS. This study shows that live births of the most socially vulnerable women in Brazil had the greatest odds of CZS. This disproportionate distribution of risk places an even greater burden on already socioeconomically disadvantaged groups, and the lifelong disabilities caused by this syndrome may reinforce existing social and health inequalities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Bmj Global Healthmentioning

confidence: 99%

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Socioeconomic risk markers of congenital Zika syndrome: a nationwide, registry-based study in Brazil

et al. 2022

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“…Moreover, abortion is highly restricted in Brazil, where it is only legal in cases of rape, when the pregnancy poses a risk to the pregnant person's life and when the fetus is anencephalic (11,12). Abortion seekers often fall out of the very narrow legal grounds for abortion or, when under their scope, find various barriers to access legal services (13,14). Many of those who cannot access legal services resort to the use of misoprostol, which is an analog of prostaglandin first introduced in the Brazilian market in 1986 to treat gastric ulcers (15).…”

Section: Introductionmentioning

confidence: 99%

“…While women with diverse socioeconomic positions have abortions, barriers to safe abortion disproportionately affect historically marginalized and impoverished population groups ( 18 ). For example, while abortion incidence is higher among women who are racialized and have lower educational levels, those same women are more likely to have unsafe abortions, to need hospitalization after a self-managed abortion, to face barriers to access post-abortion care and to be criminalized ( 8 , 14 , 18 , 19 ). On the other hand, white, educated, and richer women resort to local private clinics that offer safe abortion services clandestinely, or travel abroad to obtain legal abortions ( 19 , 20 ).…”

Section: Introductionmentioning

confidence: 99%

Social inequalities in utilization of a feminist telehealth abortion service in Brazil: A multilevel analysis

Larrea

Palència

Assis

et al. 2022

Front. Reprod. Health

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The disruption caused by the COVID-19 pandemic on health services around the world boosted interest over telehealth models of care. In Brazil, where abortion is heavily restricted, abortion seekers have long relied on international telehealth services to access abortion pills. We conducted a cross-sectional multilevel study to assess the effect of individual and contextual social factors on utilization of one such service. For the individual-level, we analyzed data from the records of abortion seekers contacting this feminist international telehealth organization during 2019 (n = 25,920). Individual-level variables were age, race, education level and pregnancy length. Contextual-level units were states, for which we used data from the national Demographic Census and Household Surveys. Contextual-level variables were household income per capita, adjusted net school attendance rate, percentage of racialized women and income Gini Index. We fitted five multilevel Poisson Mixed-effects models with robust variance to estimate prevalence ratios (PR) of service utilization, which was defined as receiving abortion pills through the service. We found that only 8.2% of requesters got abortion pills through the service. Utilization was higher among women who were older, white, more educated and 5–8-weeks pregnant. Independently of this, service utilization was higher in states with higher income and education access, with lower proportions of racialized women, and located in the South, Southeast and Central-West regions. We concluded that while feminist telehealth abortion initiatives provide a life-saving service for some abortion seekers, they are not fully equipped to overcome entrenched social inequalities in their utilization, both at individual and contextual levels.

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Abortion, Stigma, and Intersectionality

Strong

Coast

Nandagiri

2023

Handbook of Social Sciences and Global Public Health

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Barriers in Accessing Care for Consequence of Unsafe Abortion by Black Women: Evidence of Institutional Racism in Brazil

Cited by 10 publications

References 36 publications

Socioeconomic risk markers of congenital Zika syndrome: a nationwide, registry-based study in Brazil

Socioeconomic risk markers of congenital Zika syndrome: a nationwide, registry-based study in Brazil

Social inequalities in utilization of a feminist telehealth abortion service in Brazil: A multilevel analysis

Abortion, Stigma, and Intersectionality

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