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

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Abstract

Women face difficulties in accessing post-abortion care, as hierarchical care operates under discrimination mechanisms that condemn women in abortion. In addition, it is the Black and Brown women who are more subject to unsafe abortions and need hospitalization to complete the termination of pregnancy or treat associated complications. This study aimed at identifying factors associated with the institutional barriers in access to health services for women who underwent abortion by race/color. The survey encompassed 2640 users admitted to public hospitals in Salvador, Recife, and São Luís. Differences among covariables according to race/color (Black, Brown, and White women) were analyzed and tested for statistical significance using Pearson’s χ2 test. The regression analysis initially included variables that may express the technical criteria of priority in care (time of pregnancy when abortion occurred and conditions of arrival), then the sociodemographic characteristics, and, lastly, the type of abortion declared. Black women faced more institutional difficulties (27.7% vs 19.5% in White women and 18.7% in Brown women), such as waiting to be attended and getting a bed. The association between being Black women and institutional barriers remained, even after adjustments in the regression model. Institutional racism limits access to health services and timely care for Black women, acting as a performative mechanism, legitimizing and generating exclusionary behaviors. The results demonstrate that the intersection between racial discrimination and abortion stigma redouble institutional barriers that are denominated intersectional discrimination.

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Acknowledgments

The authors wish to thank the women who generously shared their stories with us and all the funders who support the research.

Funding

This research received financial support from the Brazilian Ministry of Health (DECIT) and the Ministry of Science and Technology (CNPq—Brazilian National Research Council), Call for Projects MCT/CNPq/MS-SCTIE-DECIT/CT-Health 22/2007 (n. 551249/2007-2), and MCT/CNPq/MS/SCTIE-DECIT n. 54/2008 (no. 402680/2008-1). Additional financial support was received from the Bahia State Research Foundation (FAPESB) through Call for Projects MS/CNPq/FAPESB/SESAB004/2009 Research for the SUS: Shared Management in Health PPSUS (0046/2009), and the Maranhão State Foundation for Scientific and Technological Development, through Call for Projects FAPEMA/SES-MA/MS/CNPq n. 12/2009. Case 1495/09 PPSUS (1323/09). To CAPES for the PhD scholarship of the first author of the manuscript and to CNPq for the Research Productivity Grant (309445/2006-0).

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Authors and Affiliations

  1. MUSA—Integrated Program on Gender and Health, Institute of Public Health, Federal University of Bahia, Salvador, Brazil

    Emanuelle Freitas Goes, Greice Maria de Souza Menezes & Estela Maria M. L. Aquino

  2. Instituto Gonçalo-Moniz Research Center, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil

    Maria da Conceição Chagas de Almeida

  3. Graduate Program in Public Health, Federal University of Pernambuco, Recife, Brazil

    Thália Velho Barreto-de-Araújo & Sandra Valongueiro Alves

  4. Gratuate Program in Public Health, Federal University of Maranhão, Sao Luís, Brazil

    Maria Teresa Seabra Soares de Britto Alves

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  1. Emanuelle Freitas Goes
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  2. Greice Maria de Souza Menezes
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  7. Estela Maria M. L. Aquino
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Contributions

Goes EF and Aquino EML participated in all stages of the manuscript, including conception, data analysis, interpretation, writing, and review of the final version of the manuscript. Menezes GMS and Almeida MCC participated in the data analysis, interpretation, writing, and final review of the manuscript. Barreto-de-Araújo TV, Alves SV, and Alves MT participated in the study’s conception, development, and critical revision of the final version of the manuscript.

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Correspondence to Emanuelle Freitas Goes.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethics Approval

The project was approved by the Ethics Committees of the three universities and by CONEP (CEPISC UFBA 006/09, CEP CCSUFPE 061/09, CEP HUUFMA 002065/2009-30). The study ensured the voluntary participation of the women interviewed, exempting them from the signing of the Informed Consent Form (ICF), which was read and signed exclusively by the interviewer.

Consent to Participate

The choice of the Oral Consent Form aimed at increasing the trust and protection of the interviewees, who could not be formally linked to an illegal and clandestine practice in the country. The interviews were conducted after hospital discharge, while the women were waiting for the administrative procedures to leave the hospital. All participants were given the right not to answer any questions, and the anonymity and confidentiality of their replies were safeguarded.

Additional information

This study presents data from the Gravsus survey, and the researchers, leaders of the study, are co-authors of this study.

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Freitas Goes, E., de Souza Menezes, G.M., Chagas de Almeida, M. et al. Barriers in Accessing Care for Consequence of Unsafe Abortion by Black Women: Evidence of Institutional Racism in Brazil. J. Racial and Ethnic Health Disparities 8, 1385–1394 (2021). https://doi.org/10.1007/s40615-020-00900-w

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