Why is access to health so unequal in our country? And why is the situation even more critical if you are a woman, black and poor? Health discussions involving gender, race / ethnicity and social class gained space at the UFBA 2019 Research, Teaching and Extension Congress, held on October 29-31 at the Federal University of Bahia.
Maternal mortality, one of the main themes related to women’s health, was highlighted at the table “Intersectionalizing inequities in public health: a question of race, gender and class” , held in the auditorium of the Institute of Collective Health (ISC / UFBA), at Wednesday (30). According to the latest data released by the Ministry of Health, in 2015, the country recorded 1,463 cases of deaths caused by problems in pregnancy, childbirth or up to 42 days after pregnancy.
During the debate, the nurse and doctoral student in Public Health (ISC / UFBA) Leonildo Silva warned about the impact of race and social inequalities on maternal mortality or mothers’ near miss experiences. For him, the profile of patients is well known in any maternity hospital in the country. “It is black women who are disadvantaged in obstetric care, with poorer access to health services and at higher risk of maternal death.”
Among the difficulties discussed by the table is the barrier that women face before health professionals. “There is racism and sexism in care practices,” noted psychologist Gabriela dos Santos Silva, PhD student in Public Health at ISC / UFBA. She points to activism as the main resistance strategy to confront racism in all areas.
Professor Priscila Coimbra Rocha, from the UFBA School of Nursing, also highlighted the majority presence of black women in the units of the Psychosocial Care Center (CAPS). For her, there is a process of erasing the issues that lead to greater vulnerability of this portion of the population. “What happens in the daily relationships and the trajectory of these women?” He asked.
The group also discussed the manifestations of race and social class in the diagnosis and treatment of breast cancer, the type of cancer that most kills women in the country. “In Brazil, black women are mostly the poorest. This situation causes frequent changes in the administration of the exam that identifies the tumor and the access of appropriate technology to treatment, ”explains doctoral student Taynar Pereira (ISC / UFBA), who is preparing a study on the subject.
The subject was also the agenda of the table “Inequalities, access and use of breast cancer screening services in Bahia”, which took place on Wednesday afternoon (30), in the auditorium of ISC / UFBA. “If on the one hand the occurrence is more frequent in high income countries, mortality is higher in low and middle income countries. And this is the result of many social inequalities, showing that it is necessary to have, in addition to diagnosis, an early treatment as well, ”said Professor Estela Aquino, researcher of the Integrated Program for Research and Technical Cooperation in Gender and Health (MUSA) of ISC / UFBA during the opening of the session.
Since 2012, the program team has been conducting a supplementary survey to the Longitudinal Study of Adult Health (ELSA-Brazil), which for over ten years has been monitoring the health of 15,000 employees spread across six Brazilian state capitals. Through the database provided by ELSA-Brasil, MUSA researchers intend to investigate the pattern of use of breast cancer detection services among women aged 50 and 69, active and retired civil servants living in Bahia.
In addition to the mammography exam, they investigate the frequency of gynecological consultations and the participants’ clinical breast exam. “Older women without marital union represent the subgroup that uses attention less frequently and outside the recommended periodicity,” says researcher Ana Clara Campos.
Preliminary data from the survey show that brown women with an average education level of 60 to 69 years old with children have a gynecological consultation more than 2 years apart. They are still among the most hysterectomized. Uterus removal surgery was also more frequent among women who declared themselves black, in the same age group and with children.
“Even being a more homogeneous population, the results show that there are sociodemographic differences between women, as seen in the profiles, and there are differences between groups in the use of health services,” explains researcher Emanuelle Góes, who also integrates the MUSA team.
The discussion about breast cancer extended to other tables of the UFBA 2019 Congress. On Thursday (31), the School of Nursing promoted the debate “ Reproductive Health of Rural Working Women: Not Performing Screening Tests for Breast Cancer ”. cervical cancer and breast cancer ” with the participation of Ana Cleide da Silva Dias, Gabriela Cardoso Moreira Marques, Flavia Karine Leal Lacerda and Silvia Ferreira.
On Wednesday (30), the team of the Institute of Collective Health coordinated the table “Mammography screening breast cancer in the Unified Health System: comparative analysis between interior and capital of the state of Bahia” , presented by Elissa Nascimento Cavalcante and coordinated by Karina Araújo Pinto.
“It’s for women’s lives: abortion practices in Brazil, a necessary debate” was the theme of the table held on Thursday (31), in the auditorium of the UFBA School of Nursing. The discussion was promoted by researchers from ISC / UFBA’s Integrated Program for Research and Technical Cooperation on Gender and Health (MUSA).
During the opening, Professor Greice Maria De Souza Menezes presented data on the frequency of abortions in Brazil. The estimate, according to the method employed by the Alan Guttmacher Institute (AGI), is that between 900,000 and 1.2 million abortions are caused each year in the country. Another study, used as the basis for the discussion, prepared by researcher Deborah Diniz, points to about half a million abortions caused in Brazil in 2015 alone.
According to the teacher, the inaccuracy of the numbers reveals the impact of criminalization of abortion on these notifications. She highlights verbal violence, carelessness and the threat of calling the police as one of the main obstacles. “Despite being a practice that occurs in all social classes, cases of death prevail over black women, young (under 20 years), with elementary and single education,” he points out.
The teacher pointed to the almost exclusive use of curettage, considered the most aggressive abortion procedure. Meanwhile, manual intrauterine aspiration, a technique recommended by WHO and the government itself, is only offered to 5% of women.
The table also opened space for the presentation of works developed by researchers from the UFBA Institute of Collective Health that help to understand the ways of abortion practice in Brazil and the impact on women’s lives. The first brings abortion experiences performed in private clinics in northeastern Brazil. “We found that there are different clinics and different types of care provided by doctors in these private services, but without any guarantee of safety because of the illegality of abortion,” noted researcher Paloma Silveira.
The other study, presented by researcher Emanuelle Góes, also shows that black women are in less favorable contexts for the continuity of pregnancy and have greater personal difficulties in seeking care and access to hospital care for effective postabortion care.
The discussion of the table was expanded with the presence of federal public defender Charlene Borges, who presented the legal bases and the advances on the subject. In August, the Federal Supreme Court opened for public consultation the Fundamental Precepts Arrangement (ADPF) 442. The request is for the exclusion of the two articles of the Penal Code that criminalize abortion and for the legality of the practice until the twelfth week of gestation. . Currently, abortion is only permitted in case of life-threatening women, when the pregnancy results from rape or if the fetus is anencephalic.
Reproductive rights were also ruled at other tables of the UFBA 2019 Congress. On Wednesday (30), the Faculty of Law promoted the table “ Civil liability and abortion: a critical analysis of compensation for moral and material damage in cases of abortion. without the consent of one of the parents ” , coordinated by Ana Luiza Pinheiro Flauzina and presented by Luana De Almeida de Aquino.
On Thursday (31), the School of Nursing opened space for the experience report of the short course “Legalization of abortion: a public health issue”, held in the city of Barreiras. The table was coordinated by Silvia Ferreira and presented by Paula Vielmo.