The iatrogenesis of obstetric racism in Brazil: beyond the body, beyond the clinic

Abstract

In Brazil, Black women are disproportionately denied access to timely care and are made vulnerable to death by avoidable obstetric causes. However, they have not been at the center of recent initiatives to improve maternal health. This paper contends that the effectiveness of Brazilian maternal and infant health policy is limited by failures to robustly address racial health inequities. Multi-sited ethnographic research on the implementation of the Rede Cegonha program in Bahia, Brazil between 2012 and 2017 reveals how anti-Blackness structures iatrogenic harms for Black women as well as their kin in maternal healthcare. Building on the work of Black Brazilian feminists, the paper shows how Afro-Brazilian women experience anti-Black racism in obstetric care, which the paper argues can be better understood through Dána-Ain Davis’ concept of obstetric racism. The paper suggests that such forms of violence reveal the necropolitical facets of reproductive governance and that the framing of obstetric violence broadens the scales and temporalities of iatrogenesis.

Keywords:

• Obstetric violence
• racism
• childbirth
• health policy
• Brazil

Acknowledgments

I thank Saiba Varma and Emma Varley for organizing this special issue. I also thank them, Dána-Ain Davis, Nia Georges, and two anonymous reviewers for their generous feedback and encouragement. My deepest thanks go to the women, healthcare professionals, and activists who shared their stories with me and who continue to fight for racial health justice.

Ethical approvals

This research was approved by the Rice University Institutional Review Board (Project 702001-2) and the Comissão Nacional de Ética em Pesquisa-CONEP (CAAE 56582116.2.0000.5030).

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1 All names of people and institutions have been changed to protect confidentiality.

2 Both civil and military police have a history of violence committed against Black communities in Brazil, but the military police is particularly feared (see Amnesty International 2018; Smith 2016c).

3 This paper focuses on anti-Black racism; however, racist violence in pregnancy and birth also profoundly affects Brazil’s Indigenous population (see Inter-American Commission on Human Rights 2017; Lima 2016).

4 Rede Cegonha also works to strengthen the articulations between maternal and infant healthcare services and increases funding for reproductive planning programs. Here, however, I focus primarily on the program’s promotion of low-intervention vaginal delivery.

5 As of 2018, according to the latest data available from DataSUS (http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sinasc/cnv/nvuf.def; accessed 7/29/20).

6 Here Otovo refers to what Robbie Davis-Floyd (2001) has influentially termed the ‘technocratic model’ of birth, wherein labor and delivery is doctor-centered and heavy on medical technologies and interventions.

7 “Peripheral neighborhoods,” bairros periféricos, refers to low-income districts racialized as Black.

8 What the doctor did here was likely not a cervical examination but ‘membrane stripping’, a painful procedure sometimes used to induce labor. I thank an anonymous reviewer for this observation.

9 I thank Saiba Varma for this phrasing of my intervention.

Additional information

Funding

This research was supported by the Wenner-Gren Foundation and the Fulbright-Hays program as well as the Association for Feminist Anthropology, the Brazilian Studies Association, and Rice University.