SEATTLE — In Brazil, access to healthcare before, during and after giving birth is a continuing problem for many women. Maternal healthcare in Brazil is particularly inaccessible for poor women in rural areas, and Brazil’s maternal mortality rates (MMRs) are five to 10 times higher than in countries with a similar economic status.
Based on estimates from 2015, it is clear that Brazil has made progress over the past few decades. In 1990, there were 104 maternal deaths per 100,000 live births, and by 2015, this ratio had been reduced to 44 maternal deaths per 100,000 live births. The United Nations Millennium Summit created Millenium Development Goal Five, which requires Brazil to have MMRs of no more than 35 deaths per 100,000 live births, a ratio that is currently unattainable.
Obstacles to Quality Maternal Healthcare in Brazil
Regional inequalities cause certain areas of Brazil to have higher MMRs, particularly in the poor northeastern part of the country. Rural towns are where MMRs are generally the highest, but exact MMRs are also difficult to calculate in these areas due to under-registration of deaths. Additionally, remote populations, including those in the Amazon rainforest, often do not have access to maternal healthcare in Brazil.
Even for women who do have access to medical services, the care that is provided may not be good quality, causing MMRs to continue to be high. Brazil has the highest C-section rate in the world, with nearly 50 percent of all babies delivered this way. The World Health Organization recommends that the C-section rate not exceed 15 percent, “because the possibility of excessive bleeding, blood clots, infections and complications from anesthesia makes C-sections much riskier than vaginal births,” as explained by the Yale Global Health Review. The prevalence of unnecessary C-sections is the result of poorly trained professionals and a misinformed public.
New Programs Help Women Access Care
The Brazilian government has been working to improve maternal healthcare in Brazil. In 2011, the Brazilian Ministry of Health introduced the Stork Network, a maternal and child healthcare network that aims to ensure women can access quality care. The Brazilian government passed Provisional Measure 557 in 2012, which created a registry of pregnant women, helping them access funding for prenatal care.
Decreases in MMRs accompany increases in the percentage of births attended by skilled healthcare professionals. In 1990, only 76 percent of births had skilled attendance, but in 2015, approximately 99 percent of births did.
The decentralization of healthcare in Brazil has also been crucial to reducing MMRs. When healthcare providers are able to focus on the unique socioeconomic conditions in their region, patient care improves, with increased levels of prenatal care and skilled attendance at birth.
In Bahia, a state in Brazil’s impoverished northeast, IPERBA, a perinatal institute, was established as a referral center for high-risk pregnancies. With the help of UNFPA, IPERBA has been working to provide quality healthcare to mothers. Its multidisciplinary team is able to provide patient-centered childbirth, prevent mother-to-child transmission of HIV and syphilis and help survivors of sexual assault. Between 2009 and 2011, IPERBA did not register a single maternal death.
IPERBA also develops and distributes educational materials to patients, particularly adolescent mothers, who comprise 23 percent of their hospital patients. They hold seminars and workshops with UNFPA support, eager to adapt to the needs of the local population and ensure all receive equal care.
International Efforts to Address Inadequacies of Maternal Healthcare in Brazil
Other organizations work to bring awareness to the poor state of maternal healthcare in Brazil, including the Center for Reproductive Rights, which submitted an international claim to the Convention on the Elimination of Discrimination Against Women (CEDAW) Committee on behalf of Alyne da Silva Pimentel Teixeira, who died while pregnant due to inadequate healthcare.
Alyne passed away in 2002 after visiting a private health clinic in Rio de Janeiro. Doctors ignored signs of high-risk pregnancy, and when she returned to the hospital and no fetal heartbeat was detected, they transferred her to a higher tier healthcare institution. The transfer took a great amount of time, and Alyne died after 21 hours without medical care.
The CEDAW Committee found the Brazilian state responsible for Alyne’s death because they were not properly regulating the activities of private health providers. The committee reasoned in its report on the case, “Whenever states are legally bound to provide universal access to health, they become directly responsible for monitoring and regulating private institutions that provide health services through outsourcing, making them accountable for their actions.”
They tasked Brazil with providing adequate professional training for health workers, ensuring that healthcare facilities comply with international standards and holding health professionals who violate women’s reproductive health rights responsible for their actions. This case helped bring international attention to MMRs in Brazil.
This spring, the Bill and Melinda Gates Foundation partnered with the Brazilian Ministry of Health, the National Council for Scientific and Technological Development and the National Council for State Funding Agencies to provide funding for research projects that will address priority issues in maternal and child health in Brazil.
The Bill and Melinda Gates Foundation explained in a statement for Grand Challenges that “The purpose of this call for proposals is to promote new and novel approaches to analyzing data related to social programs and public health in Brazil to produce novel insights which can be used to improve maternal and child healthcare in Brazil and around the world.” These efforts are another part of the fight to improve maternal healthcare in Brazil and reduce MMRs in the nation.
– Sara Olk