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1.
Ethn Health ; 29(1): 46-61, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37642313

RESUMO

OBJECTIVES: There is limited evidence regarding the impact of race/racism and its intersection with socioeconomic status (SES) on breast and cervical cancer, the two most common female cancers globally. We investigated racial inequalities in breast and cervical cancer mortality and whether SES (education and household conditions) interacted with race/ethnicity. DESIGN: The 100 Million Brazilian Cohort data were linked to the Brazilian Mortality Database, 2004-2015 (n = 20,665,005 adult women). We analysed the association between self-reported race/ethnicity (White/'Parda'(Brown)/Black/Asian/Indigenous) and cancer mortality using Poisson regression, adjusting for age, calendar year, education, household conditions and area of residence. Additive and multiplicative interactions were assessed. RESULTS: Cervical cancer mortality rates were higher among Indigenous (adjusted Mortality rate ratio = 1.80, 95%CI 1.39-2.33), Asian (1.63, 1.20-2.22), 'Parda'(Brown) (1.27, 1.21-1.33) and Black (1.18, 1.09-1.28) women vs White women. Breast cancer mortality rates were higher among Black (1.10, 1.04-1.17) vs White women. Racial inequalities in cervical cancer mortality were larger among women of poor household conditions, and low education (P for multiplicative interaction <0.001, and 0.02, respectively). Compared to White women living in completely adequate (3-4) household conditions, the risk of cervical cancer mortality in Black women with 3-4, 1-2, and none adequate conditions was 1.10 (1.01-1.21), 1.48 (1.28-1.71), and 2.03 (1.56-2.63), respectively (Relative excess risk due to interaction-RERI = 0.78, 0.18-1.38). Among 'Parda'(Brown) women the risk was 1.18 (1.11-1.25), 1.68 (1.56-1.81), and 1.84 (1.63-2.08), respectively (RERI = 0.52, 0.16-0.87). Compared to high-educated White women, the risk in high-, middle- and low-educated Black women was 1.14 (0.83-1.55), 1.93 (1.57-2.38) and 2.75 (2.33-3.25), respectively (RERI = 0.36, -0.05-0.77). Among 'Parda'(Brown) women the risk was 1.09 (0.91-1.31), 1.99 (1.70-2.33) and 3.03 (2.61-3.52), respectively (RERI = 0.68, 0.48-0.88). No interactions were found for breast cancer. CONCLUSION: Low SES magnified racial inequalities in cervical cancer mortality. The intersection between race/ethnicity, SES and gender needs to be addressed to reduce racial health inequalities.


Assuntos
Neoplasias da Mama , Desigualdades de Saúde , Neoplasias do Colo do Útero , Adulto , Feminino , Humanos , Brasil/epidemiologia , Neoplasias da Mama/mortalidade , Etnicidade , Classe Social , Fatores Socioeconômicos , Neoplasias do Colo do Útero/mortalidade , Grupos Raciais
2.
Lancet Glob Health ; 11(11): e1734-e1742, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37858584

RESUMO

BACKGROUND: This study estimated ethnoracial inequalities in maternal and congenital syphilis in Brazil, understanding race as a relational category product of a sociopolitical construct that functions as an essential tool of racism and its manifestations. METHODS: We linked routinely collected data from Jan 1, 2012 to Dec 31, 2017 to conduct a population-based study in Brazil. We estimated the attributable fraction of race (skin colour) for the entire population and specific subgroups compared with White women using adjusted logistic regression. We also obtained the attributable fraction of the intersection between two social markers (race and education) and compared it with White women with more than 12 years of education as the baseline. FINDINGS: Of 15 810 488 birth records, 144 564 women had maternal syphilis and 79 580 had congenital syphilis. If all women had the same baseline risk as White women, 35% (95% CI 34·89-36·10) of all maternal syphilis and 41% (40·49-42·09) of all congenital syphilis would have been prevented. Compared with other ethnoracial categories, these percentages were higher among Parda/Brown women (46% [45·74-47·20] of maternal syphilis and 52% [51·09-52·93] of congenital syphilis would have been prevented) and Black women (61% [60·25-61·75] of maternal syphilis and 67% [65·87-67·60] of congenital syphilis would have been prevented). If all ethnoracial groups had the same risk as White women with more than 12 years of education, 87% of all maternal syphilis and 89% of all congenital syphilis would have been prevented. INTERPRETATION: Only through effective control of maternal syphilis among populations at higher risk (eg, Black and Parda/Brown women with lower educational levels) can WHO's global health initiative to eliminate mother-to-child transmission of syphilis be made feasible. Recognising that racism and other intersecting forms of oppression affect the lives of minoritised groups and advocating for actions through the lens of intersectionality is imperative for attaining and guaranteeing health equity. Achieving health equality needs to be addressed to achieve syphilis control. Given the scale and complexity of the problem (which is unlikely to be unique to Brazil), structural issues and social markers of oppression, such as race and education, must be considered to prevent maternal and congenital syphilis and improve maternal and child outcomes globally. FUNDING: Wellcome Trust, CNPq-Brazil. TRANSLATION: For the Portuguese translation of the abstract see Supplementary Materials section.


Assuntos
Complicações Infecciosas na Gravidez , Sífilis Congênita , Sífilis , Gravidez , Feminino , Humanos , Sífilis Congênita/prevenção & controle , Sífilis/epidemiologia , Sífilis/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Brasil/epidemiologia , Estudos Longitudinais , Transmissão Vertical de Doenças Infecciosas/prevenção & controle
3.
Lancet Reg Health Am ; 20: 100455, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36890851

RESUMO

Background: To understand if migrants living in poverty in low and middle-income countries (LMICs) have mortality advantages over the non-migrant population, we investigated mortality risk patterns among internal and international migrants in Brazil over their life course. Methods: We linked socio-economic and mortality data from 1st January 2011 to 31st December 2018 in the 100 Million Brazilian Cohort and calculated all-cause and cause-specific age-standardised mortality rates according to individuals' migration status for men and women. Using Cox regression models, we estimated the age- and sex-adjusted mortality hazard ratios (HR) for internal migrants (i.e., Brazilian-born individuals living in a different Brazilian state than their birth) compared to Brazilian-born non-migrants; and for international migrants (i.e., people born in another country) compared to Brazilian-born individuals. Findings: The study followed up 45,051,476 individuals, of whom 6,057,814 were internal migrants, and 277,230 were international migrants. Internal migrants had similar all-cause mortality compared to Brazilian non-migrants (aHR = 0.99, 95% CI = 0.98-0.99), marginally higher mortality for ischaemic heart diseases (aHR = 1.04, 95% CI = 1.03-1.05) and higher for stroke (aHR = 1.11, 95% CI = 1.09-1.13). Compared to Brazilian-born individuals, international migrants had 18% lower all-cause mortality (aHR = 0.82, 95% CI = 0.80-0.84), with up to 50% lower mortality from interpersonal violence among men (aHR = 0.50, 95% CI = 0.40-0.64), but higher mortality from avoidable causes related to maternal health (aHR = 2.17, 95% CI = 1.17-4.05). Interpretation: Although internal migrants had similar all-cause mortality, international migrants had lower all-cause mortality compared to non-migrants. Further investigations using intersectional approaches are warranted to understand the marked variations by migration status, age, and sex for specific causes of death, such as elevated maternal mortality and male lower interpersonal violence-related mortality among international migrants. Funding: The Wellcome Trust.

4.
Rev. bras. estud. popul ; 40: e0247, 2023. tab, graf
Artigo em Inglês | LILACS, Coleciona SUS | ID: biblio-1521756

RESUMO

Abstract This article aims to analyze residential segregation by race (racial segregation) and income (economic segregation) in Brazil and explore its relationship with socioeconomic and socio-spatial factors. Residential segregation was assessed using the dissimilarity index based on the 2010 demographic census and considering urban census tracts since segregation is sociologically considered an urban problem. The results for racial segregation showed that it is more evident in cities in the South and Southeast of Brazil and mainly affects the self-declared black population. The approach used to calculate economic segregation involved examining the income level of different low-income groups. Therefore, we consider families that earned between 0 and 1 minimum wage as the group with the greatest social vulnerability. We did not find significant correlations between racial and income segregation indices with aspects such as urbanization (urban population size). Finally, we present the racial segregation indices stratifying families by income thresholds for the 27 Brazilian capitals and conclude that per capita household income is a preponderant factor for the segregation of the poorest, especially in families whose residents self-identify as black.


Resumo Este artigo tem como objetivo analisar a segregação residencial por raça (segregação racial) e renda (segregação econômica) no Brasil e explorar sua relação com fatores socioeconômicos e socioespaciais. A segregação residencial foi avaliada pelo índice de dissimilaridade baseado no Censo Demográfico de 2010 e considerando setores censitários urbanos, uma vez que a segregação é entendida sociologicamente como um problema urbano. Os resultados mostram que a segregação racial é mais evidente nas cidades do Sul e Sudeste do Brasil, atingindo principalmente a população autodeclarada preta. A abordagem utilizada para calcular a segregação econômica envolveu examinar o nível de renda de diferentes grupos de baixa renda. Portanto, consideramos as famílias que ganham entre 0 e 1 salário mínimo - o grupo de maior vulnerabilidade social. Não encontramos correlações significativas entre os índices de segregação racial e de renda com fatores como a urbanização (tamanho da população urbana). Por fim, apresentamos os índices de segregação racial estratificando as famílias por faixas de renda para as 27 capitais brasileiras e concluímos que a renda domiciliar per capita é fator preponderante para a segregação dos mais pobres, principalmente nas famílias cujos moradores se autodeclaram pretos.


Resumen Este artículo tiene como objetivo analizar la segregación residencial por raza (segregación racial) y renta (segregación económica) en Brasil y explorar su relación con factores socioeconómicos y socioespaciales. La segregación residencial se evaluó utilizando el índice de disimilitud con base en el censo demográfico de 2010 y considerando las secciones censales urbanas ya que la segregación es considerada sociológicamente como un problema urbano. Los resultados para la segregación racial mostraron que esta es más evidente en ciudades del sur y del sudeste de Brasil y que afecta principalmente a la población autodeclarada negra. El enfoque usado para calcular la segregación económica implicó examinar el nivel de ingresos de diferentes grupos de bajos ingresos. Por lo tanto, consideramos que las familias que ganaban entre cero y un salario mínimo son el grupo con mayor vulnerabilidad social. No encontramos correlaciones significativas entre los índices de segregación racial y los de ingresos con factores como la urbanización (tamaño de la población urbana). Finalmente, presentamos los índices de segregación racial estratificando a las familias por umbrales de renta para las 27 capitales brasileñas y concluimos que la renta per cápita de los hogares es un factor preponderante para la segregación de los más pobres, en especial en las familias cuyos habitantes se autodeclaran negros.


Assuntos
Humanos , Fatores Socioeconômicos , População Negra , Segregação Social , Instabilidade Habitacional , Segregação Residencial , Censos , Índice de Vulnerabilidade Social , Vulnerabilidade Social
5.
Lancet Glob Health ; 10(10): e1453-e1462, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36113530

RESUMO

BACKGROUND: Racism is a social determinant of health inequities. In Brazil, racial injustices lead to poor outcomes in maternal and child health for Black and Indigenous populations, including greater risks of pregnancy-related complications; decreased access to antenatal, delivery, and postnatal care; and higher childhood mortality rates. In this study, we aimed to estimate inequalities in childhood mortality rates by maternal race and skin colour in a cohort of more than 19 million newborns in Brazil. METHODS: We did a nationwide population-based, retrospective cohort study using linked data on all births and deaths in Brazil between Jan 1, 2012, and Dec 31, 2018. The data consisted of livebirths followed up to age 5 years, death, or Dec 31, 2018. Data for livebirths were extracted from the National Information System for livebirths, SINASC, and for deaths from the Mortality Information System, SIM. The final sample consisted of complete data for all cases regarding maternal race and skin colour, and no inconsistencies were present between date of birth and death after linkage. We fitted Cox proportional hazard regression models to calculate the crude and adjusted hazard ratios (HRs) and 95% CIs for the association between maternal race and skin colour and all-cause and cause-specific younger than age 5 mortality rates, by age subgroups. We calculated the trend of HRs (and 95% CI) by time of observation (calendar year) to indicate trends in inequalities. FINDINGS: From the 20 526 714 livebirths registered in SINASC between Jan 1, 2012, and Dec 31, 2018, 238 436 were linked to death records identified from SIM. After linkage, 1 010 871 records were excluded due to missing data on maternal race or skin colour or inconsistent date of death. 19 515 843 livebirths were classified by mother's race, of which 224 213 died. Compared with children of White mothers, mortality risk for children younger than age 5 years was higher among children of Indigenous (HR 1·98 [95% CI 1·92-2·06]), Black (HR 1·39 [1·36-1·41]), and Brown or Mixed race (HR 1·19 [1·18-1·20]) mothers. The highest hazard ratios were observed during the post-neonatal period (Indigenous, HR 2·78 [95% CI 2·64-2·95], Black, HR 1·54 [1·48-1·59]), and Brown or Mixed race, HR 1·25 [1·23-1·27]) and between the ages of 1 year and 4 years (Indigenous, HR 3·82 [95% CI 3·52-4·15]), Black, HR 1·51 [1·42-1·60], and Brown or Mixed race, HR 1·30 [1·26-1·35]). Children of Indigenous (HR 16·39 [95% CI 12·88-20·85]), Black (HR 2·34 [1·78-3·06]), and Brown or Mixed race mothers (HR 2·05 [1·71-2·45]) had a higher risk of death from malnutrition than did children of White mothers. Similar patterns were observed for death from diarrhoea (Indigenous, HR 14·28 [95% CI 12·25-16·65]; Black, HR 1·72 [1·44-2·05]; and Brown or Mixed race mothers, HR 1·78 [1·61-1·98]) and influenza and pneumonia (Indigenous, HR 6·49 [95% CI 5·78-7·27]; Black, HR 1·78 [1·62-1·96]; and Brown or Mixed race mothers, HR 1·60 [1·51-1·69]). INTERPRETATION: Substantial ethnoracial inequalities were observed in child mortality in Brazil, especially among the Indigenous and Black populations. These findings demonstrate the importance of regular racial inequality assessments and monitoring. We suggest implementing policies to promote ethnoracial equity to reduce the impact of racism on child health. FUNDING: MCTI/CNPq/MS/SCTIE/Decit/Bill & Melinda Gates Foundation's Grandes Desafios Brasil, Desenvolvimento Saudável para Todas as Crianças, and Wellcome Trust core support grant awarded to CIDACS-Center for Data and Knowledge Integration for Health.


Assuntos
Mortalidade da Criança , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Gravidez , Estudos Retrospectivos , Fatores Socioeconômicos
6.
J Racial Ethn Health Disparities ; 9(4): 1506-1516, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-34173224

RESUMO

OBJECTIVE: To explore racial disparities in self-reports of violent victimization and polyvictimization among young girls in Brazil and to analyze the distribution of prevalence rates across race groups and the estimated odds of exposure. DESIGN: Data from girls ages 15 and above (N=14,809) from the 2015 edition of PeNSE (National Adolescent School-based Health Survey) were analyzed. Survey weighted proportions and bivariate and multivariate logistic regressions were used to address the objectives. RESULTS: Independent of the girls' age, socioeconomic status, and region of residence, black, indigenous, mixed, and Asian descendant girls (relative to Whites) were more likely to report past experiences of being bullied, suffering physical violence, forced sexual intercourse, and polyvictimization (reporting all three events). Blacks had the highest rates of reporting being bullied and polyvictimization. Asian descendants had the highest reports of physical violence. Indigenous girls had the highest reports of forced sexual intercourse. CONCLUSIONS: This study documented disproportionate risks of violent victimization for young women of color among Brazilian students. The risks were significantly greater for those of darker skin tones and from ethnic minorities. IMPLICATIONS: These findings can inform the development of programs to protect young women from violence in Brazil and highlight the importance of including anti-racism strategies in such programs.


Assuntos
Bullying , Vítimas de Crime , Adolescente , Brasil/epidemiologia , Feminino , Humanos , Autorrelato , Violência
7.
J Racial Ethn Health Disparities ; 8(6): 1385-1394, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-33439462

RESUMO

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.


Assuntos
Aborto Induzido , Racismo , Brasil , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Gravidez , Estigma Social , Racismo Sistêmico
9.
Cad Saude Publica ; 36Suppl 1(Suppl 1): e00189618, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32049120

RESUMO

Social inequalities in Brazil are reflected in women's search for abortion care, when they face individual, social, and structural barriers and are exposed to situations of vulnerability. Black women are the most heavily exposed to these barriers, from the search for the service to the care itself. The study aimed to analyze factors related to individual barriers in the search for first post-abortion care according to race/color. The study was conducted in Salvador (Bahia State), Recife, (Pernambuco State) and São Luís (Maranhão State), Brazil, with 2,640 patients admitted to public hospitals. Logistic regression was performed to analyze differences according to race/color (white, brown, and black), with "no individual barriers in the search for first care" as the reference category in the dependent variable. Of the women interviewed, 35.7% were black, 53.3% brown, and 11% white. Black women had less schooling, fewer children, and reported more induced abortions (31.1%) and more second-trimester abortions (15.4%). Black women reported more individual barriers in the search for first care (32% vs. 28% in brown women and 20.3% in whites), such as fear of being mistreated and lack of money for transportation. Regression analysis confirmed the association between black and brown race/color and individual barriers in the search for post-abortion care, even after adjusting for all the selected variables. The results confirmed the situation of vulnerability for black women and brown women in Brazil. Racial discrimination in health services and abortion-related stigma can act simultaneously, delaying women's access to health services, a limitation that can further complicate their post-abortion condition.


As desigualdades sociais no Brasil se refletem na busca por atenção pelas mulheres com abortamento, as quais enfrentam barreiras individuais, sociais e estruturais, expondo-as a situações de vulnerabilidades. São as negras as mais expostas a essas barreiras, desde a procura pelo serviço até o atendimento. O estudo objetivou analisar os fatores relacionados às barreiras individuais na busca do primeiro atendimento pós-aborto segundo raça/cor. A pesquisa foi realizada em Salvador (Bahia), Recife (Pernambuco) e São Luís (Maranhão), Brasil, com 2.640 usuárias internadas em hospitais públicos. Foi realizada regressão logística para análise das diferenças segundo raça/cor (branca, parda e preta), considerando-se "não houve barreiras individuais na busca pelo primeiro atendimento" como categoria de referência da variável dependente. Das entrevistadas, 35,7% eram pretas, 53,3% pardas e 11% brancas. Mulheres pretas tinham menor escolaridade, menos filhos e declararam mais o aborto como provocado (31,1%), após 12 semanas de gestação (15,4%). Relataram mais barreiras individuais na busca pelo primeiro atendimento (32% vs. 28% entre pardas e 20,3% entre brancas), tais como o medo de ser maltratada e não ter dinheiro para o transporte. Na regressão, confirmou-se a associação entre raça/cor preta e parda e barreiras individuais na busca de cuidados pós-aborto, mesmo após o ajuste por todas as variáveis selecionadas. Os resultados confirmam a situação de vulnerabilidade das pretas e pardas. A discriminação racial nos serviços de saúde e o estigma em relação ao aborto podem atuar simultaneamente, retardando a ida das mulheres ao serviço, o que pode configurar uma situação limite de maior agravamento do quadro pós-abortamento.


Las desigualdades sociales en Brasil se reflejan en la búsqueda de atención sanitaria por parte de las mujeres que abortan, que enfrentan barreras individuales, sociales y estructurales, exponiéndolas a situaciones de vulnerabilidad. Las negras son las más expuestas a estas barreras, desde la búsqueda del servicio hasta la atención. El estudio tuvo como objetivo analizar los factores relacionados con las barreras individuales en la búsqueda de la primera atención post-aborto según raza/color. La investigación se realizó en Salvador (Bahia), Recife (Pernambuco) y São Luis (Maranhão), Brasil, con 2.640 pacientes internadas en hospitales públicos. Se realizó una regresión logística para el análisis de las diferencias según raza/color (blanca, mulata/mestiza y negra), considerándose "no tuvo barreras individuales en la búsqueda de la primera atención" como categoría de referencia de la variable dependiente. De las entrevistadas 35,7% eran negras, 53,3% mulatas/mestizas y 11% blancas. Las mujeres negras tenían menor escolaridad, menos hijos y declararon más el aborto como provocado (31,1%), tras 12 semanas de gestación (15,4%). Informaron más barreras individuales en la búsqueda de la primera atención (32% vs. 28% entre multas/mestizas y un 20,3% entre las blancas), tales como el miedo de ser maltratada y no tener dinero para el transporte. En la regresión se confirmó la asociación entre raza/color negro y mulato/mestizo y barreras individuales en la búsqueda de cuidados post-aborto, incluso tras el ajuste por todas las variables seleccionadas. Los resultados confirman la situación de vulnerabilidad de las negras y mulatas/mestizas. La discriminación racial en los servicios de salud y el estigma en relación con el aborto pueden actuar simultáneamente, retardando la ida de las mujeres al servicio de salud, lo que puede constituir una situación límite de mayor gravedad en el cuadro post-aborto.


Assuntos
Aborto Induzido , Acessibilidade aos Serviços de Saúde , Brasil , Criança , Feminino , Humanos , Gravidez , Estigma Social , Inquéritos e Questionários
10.
Saúde debate ; 44(spe4): 324-340, 2020.
Artigo em Português | LILACS-Express | LILACS | ID: biblio-1290134

RESUMO

RESUMO Esta revisão narrativa sintetizou evidências científicas sobre desigualdades de gênero e raça na pandemia de Covid-19, enfocando o trabalho produtivo/reprodutivo das mulheres, a violência de gênero e o acesso aos Serviços de Saúde Sexual e Reprodutiva (SSR). Os resultados confirmam que as desigualdades sociais devem ser consideradas para o efetivo controle da pandemia e para a preservação de direitos. Para além dos efeitos diretos do SARS-CoV-2, discute-se que barreiras de acesso a serviços de SSR podem ocasionar o aumento de gravidezes não pretendidas, abortos inseguros e mortalidade materna. O distanciamento social tem obrigado muitas mulheres a permanecer confinadas com seus agressores e dificultado o acesso a serviços de denúncia, incorrendo no aumento da violência de gênero e em desfechos graves à saúde. Como principais responsáveis pelo cuidado, as mulheres estão mais expostas a adoecer nas esferas profissional e doméstica. A conciliação trabalho-família tornou-se mais difícil para elas durante a pandemia. A literatura naturaliza as diferenças de gênero, raça e classe, com ênfase em fatores de risco. Uma agenda de pesquisa com abordagem interseccional é necessária para embasar a formulação de políticas que incorporem os direitos humanos e atendam às necessidades dos grupos mais vulneráveis à Covid-19.


ABSTRACT This narrative review synthesized scientific evidence on gender and race inequalities in the Covid-19 pandemic, focusing on women's productive/reproductive work, gender-based violence, and the access to Sexual and Reproductive Health Services (SRHS). The results demonstrated that social inequalities must be considered for the effective control of the pandemic and for the preservation of rights. Besides the direct effects of SARS-CoV-2, the literature discusses that barriers to access SRHS can lead to an increase in unintended pregnancies, unsafe abortions, and maternal mortality. Also, social distancing has led several women to stay confined with their aggressors, which hinders the access to reporting services, incurring in the increase of gender-based violence and severe outcomes to health. As main responsible for the care, women are more prone to getting the virus in both professional and domestic spheres. The conciliation between work and family has become more difficult for them during the pandemic. Literature naturalizes gender, race, and social class differences, emphasizing risk factors. An intersectional research plan is needed to support the making of public policies that incorporate human rights and meet the needs of the most vulnerable to Covid-19.

11.
Cad. Saúde Pública (Online) ; 36(supl.1): e00189618, 2020. tab, graf
Artigo em Português | LILACS | ID: biblio-1055643

RESUMO

As desigualdades sociais no Brasil se refletem na busca por atenção pelas mulheres com abortamento, as quais enfrentam barreiras individuais, sociais e estruturais, expondo-as a situações de vulnerabilidades. São as negras as mais expostas a essas barreiras, desde a procura pelo serviço até o atendimento. O estudo objetivou analisar os fatores relacionados às barreiras individuais na busca do primeiro atendimento pós-aborto segundo raça/cor. A pesquisa foi realizada em Salvador (Bahia), Recife (Pernambuco) e São Luís (Maranhão), Brasil, com 2.640 usuárias internadas em hospitais públicos. Foi realizada regressão logística para análise das diferenças segundo raça/cor (branca, parda e preta), considerando-se "não houve barreiras individuais na busca pelo primeiro atendimento" como categoria de referência da variável dependente. Das entrevistadas, 35,7% eram pretas, 53,3% pardas e 11% brancas. Mulheres pretas tinham menor escolaridade, menos filhos e declararam mais o aborto como provocado (31,1%), após 12 semanas de gestação (15,4%). Relataram mais barreiras individuais na busca pelo primeiro atendimento (32% vs. 28% entre pardas e 20,3% entre brancas), tais como o medo de ser maltratada e não ter dinheiro para o transporte. Na regressão, confirmou-se a associação entre raça/cor preta e parda e barreiras individuais na busca de cuidados pós-aborto, mesmo após o ajuste por todas as variáveis selecionadas. Os resultados confirmam a situação de vulnerabilidade das pretas e pardas. A discriminação racial nos serviços de saúde e o estigma em relação ao aborto podem atuar simultaneamente, retardando a ida das mulheres ao serviço, o que pode configurar uma situação limite de maior agravamento do quadro pós-abortamento.


Las desigualdades sociales en Brasil se reflejan en la búsqueda de atención sanitaria por parte de las mujeres que abortan, que enfrentan barreras individuales, sociales y estructurales, exponiéndolas a situaciones de vulnerabilidad. Las negras son las más expuestas a estas barreras, desde la búsqueda del servicio hasta la atención. El estudio tuvo como objetivo analizar los factores relacionados con las barreras individuales en la búsqueda de la primera atención post-aborto según raza/color. La investigación se realizó en Salvador (Bahia), Recife (Pernambuco) y São Luis (Maranhão), Brasil, con 2.640 pacientes internadas en hospitales públicos. Se realizó una regresión logística para el análisis de las diferencias según raza/color (blanca, mulata/mestiza y negra), considerándose "no tuvo barreras individuales en la búsqueda de la primera atención" como categoría de referencia de la variable dependiente. De las entrevistadas 35,7% eran negras, 53,3% mulatas/mestizas y 11% blancas. Las mujeres negras tenían menor escolaridad, menos hijos y declararon más el aborto como provocado (31,1%), tras 12 semanas de gestación (15,4%). Informaron más barreras individuales en la búsqueda de la primera atención (32% vs. 28% entre multas/mestizas y un 20,3% entre las blancas), tales como el miedo de ser maltratada y no tener dinero para el transporte. En la regresión se confirmó la asociación entre raza/color negro y mulato/mestizo y barreras individuales en la búsqueda de cuidados post-aborto, incluso tras el ajuste por todas las variables seleccionadas. Los resultados confirman la situación de vulnerabilidad de las negras y mulatas/mestizas. La discriminación racial en los servicios de salud y el estigma en relación con el aborto pueden actuar simultáneamente, retardando la ida de las mujeres al servicio de salud, lo que puede constituir una situación límite de mayor gravedad en el cuadro post-aborto.


Social inequalities in Brazil are reflected in women's search for abortion care, when they face individual, social, and structural barriers and are exposed to situations of vulnerability. Black women are the most heavily exposed to these barriers, from the search for the service to the care itself. The study aimed to analyze factors related to individual barriers in the search for first post-abortion care according to race/color. The study was conducted in Salvador (Bahia State), Recife, (Pernambuco State) and São Luís (Maranhão State), Brazil, with 2,640 patients admitted to public hospitals. Logistic regression was performed to analyze differences according to race/color (white, brown, and black), with "no individual barriers in the search for first care" as the reference category in the dependent variable. Of the women interviewed, 35.7% were black, 53.3% brown, and 11% white. Black women had less schooling, fewer children, and reported more induced abortions (31.1%) and more second-trimester abortions (15.4%). Black women reported more individual barriers in the search for first care (32% vs. 28% in brown women and 20.3% in whites), such as fear of being mistreated and lack of money for transportation. Regression analysis confirmed the association between black and brown race/color and individual barriers in the search for post-abortion care, even after adjusting for all the selected variables. The results confirmed the situation of vulnerability for black women and brown women in Brazil. Racial discrimination in health services and abortion-related stigma can act simultaneously, delaying women's access to health services, a limitation that can further complicate their post-abortion condition.


Assuntos
Humanos , Feminino , Gravidez , Criança , Aborto Induzido , Acessibilidade aos Serviços de Saúde , Brasil , Inquéritos e Questionários , Estigma Social
12.
Trab. educ. saúde ; 18(3): e00278110, 2020.
Artigo em Português | LILACS | ID: biblio-1139773

RESUMO

Resumo O racismo é um sistema estruturante, gerador de comportamentos, práticas, crenças e preconceitos que fundamentam desigualdades evitáveis e injustas, baseadas na raça ou etnia. Na saúde o racismo pode se manifestar de diversas formas, como o institucional, que frequentemente ocorre de forma implícita. A pandemia do coronavírus tem sido um desafio para países que apresentam profundas desigualdades. No Brasil, em que pese a ausência das informações desagregadas por raça ou etnia ou que quando coletadas apresentam um preenchimento precário, sabe-se que negras e negros irão sofrer mais severamente os impactos da pandemia e seus vários desfechos negativos. No texto recuperamos aspectos históricos e sua relação com as condições de vulnerabilidade da população negra e apresentamos uma agenda de ações específicas para o combate ao racismo e suas devastadoras consequências no contexto da Covid-19.


Abstract Racism is a structural system that generates behaviors, practices, beliefs and prejudices that underlie unfair and avoidable inequalities, based on race or ethnicity. In health, racism can manifest itself in several ways, including institutional racism, which often occurs covertly. The coronavirus pandemic has been a challenge for countries with profound inequalities. In Brazil, despite the absence of information disaggregated by race or ethnicity, and even when collected, oftentimes recorded with errors; it is known that black people will suffer more sever impacts of the pandemic as well as its various negative outcomes. In this article we recall historical aspects and their relationship with the vulnerability of black population as well as suggest specific actions to combat racism and its devastating consequences in the context of COVID-19.


Resumen El racismo es un sistema estructural, que genera comportamientos, prácticas, creencias y prejuicios que dan fundamento a desigualdades que son evitables e injustas, basadas en la raza o etnia. En la salud, el racismo se puede manifestar de varias maneras, como la institucional, que a menudo ocurre de manera implícita. La pandemia del coronavirus ha sido un desafío para países que presentan grandes desigualdades. En Brasil, a pesar de la falta de información separadas por raza o etnia, o que, cuando se recopila, las respuestas son incompletas; se sabe que la raza negra, sufrirán mucho más los impactos de la pandemia y los diversos resultados negativos. En el texto recuperamos aspectos históricos y su relación con las condiciones de vulnerabilidad de la población negra y presentamos un plan de acciones específicas para combatir el racismo y sus consecuencias devastadoras dentro del contexto de Covid-19.


Assuntos
Humanos , Infecções por Coronavirus , Racismo
13.
Subst Use Misuse ; 54(7): 1214-1225, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30799670

RESUMO

BACKGROUND: Discrimination is detrimental to physical and mental health, particularly insofar as health-risk behaviors are concerned. Particular attention has been paid to excess alcohol consumption and smoking in view of the ready availability of these substances in Western societies. OBJECTIVES: To determine whether an association exists between perceived discrimination and excess alcohol intake and smoking in women and men enrolled in the ELSA-Brasil cohort study. METHODS: The sample included in the ELSA-Brasil cohort consisted of 15,105 civil servants. Data from waves 1 and 2 of the study were used. A multidimensional questionnaire was used to collect sociodemographic characteristics and evaluate perceived discrimination, alcohol consumption, and smoking. RESULTS: An association was found between excess alcohol intake and perceived discrimination only in the men, with this association remaining significant in the youngest age group, in university-educated individuals, and in the group classified as middle-class. An association was found between smoking and lifetime perceived discrimination in women, particularly in those ≥60 years of age, brown-skinned women, those who had completed elementary school, and those classified as upper social class. This same association was found in the men, mainly those of 50-59 years of age, white-skinned males, those who had completed high school, those with a university education, and those classified as upper social class. Conclusions/Importance: Investing in public health policies aimed at combating the different forms of discrimination would appear essential. Not only does discrimination contribute to social injustice, but it also encourages health-risk behaviors such as excess alcohol intake and smoking.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Racismo , Uso de Tabaco/epidemiologia , Adulto , Fatores Etários , Brasil/epidemiologia , Estudos de Coortes , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Classe Social , Inquéritos e Questionários
14.
Saúde debate ; 37(99): 571-579, out.-dez. 2013. tab
Artigo em Português | LILACS-Express | LILACS | ID: lil-702073

RESUMO

O racismo institucional é um fator determinante no acesso aos serviços de saúde, principalmente para as mulheres negras que sofrem com o impacto das intersecções das desigualdades de gênero e raça. O objetivo deste estudo é determinar os diferenciais das características sócio demográficas e os níveis de acesso aos serviços preventivos de mulheres na Bahia, segundo raça/cor. Os resultados revelam que, para o nível de acesso considerado bom, as mulheres brancas representam 15,4%, enquanto as negras respondem por 7,9%. O estudo demonstrou que as desigualdades raciais e o racismo institucional são uma barreira no acesso aos serviços preventivos de saúde para as mulheres negras.


Institutional racism is a determining factor for accessing health services, mainly for those black women who suffer the impact of gender and race inequalities' intersections. This study aims to ascertain the differences among socio-demographic characteristics and access levels to preventive services for women in Bahia as for race/color. The results noted that from those entitled to the good access level 15.4% were white women while 7.9% were black ones. The study showed that racial inequalities and institutional racism are barriers against the access to preventive health services regarding black women.

15.
Salvador; s.n; 2011. 82P p.
Tese em Português | BDENF - Enfermagem, LILACS | ID: biblio-1121221

RESUMO

As desigualdades estruturam as relações sociais e determinam as condições de vida das pessoas. Em relação às desigualdades raciais na saúde, o racismo institucional é um fator determinante no acesso aos serviços de saúde, principalmente para as mulheres negras que sofrem com o impacto das intersecções das desigualdades de gênero e raça, situação que tem maior agravamento, quando comparada ao que ocorre com as mulheres brancas. Este estudo tem por objetivo geral analisar as desigualdades raciais no acesso de mulheres maiores de 25 anos aos serviços preventivos de saúde na Bahia; e, como objetivos específicos: analisar características sociodemográficas e de saúde de mulheres na Bahia, segundo raça/cor; determinar diferenciais das características sociodemográficas e de saúde, em relação ao acesso aos serviços preventivos de mulheres na Bahia, segundo raça/cor. Como modelo teórico, definiu-se pela Teoria da Determinação Social da saúde. Trata-se de um estudo descritivo de base populacional. Sendo a população definida para o estudo mulheres negras e brancas com 25 anos ou mais de idade, residentes na Bahia, que responderam ao questionário da Pesquisa Nacional de Amostra por Domicilio (PNAD) do ano de 2008. Foram utilizados os programas SPSS 17.0 e o STATA (v. 8.0) para armazenamento, tratamento das variáveis e construção do indicador de acesso. Foram realizados teste qui-quadrado Pearson e exato de Fisher para verificar as diferenças entre as proporções das características sociodemográficas e dos níveis de acesso (bom, regular e ruim), segundo a raça/cor. Sobre as características sociodemográficas os resultados apontam que as mulheres negras representam 79,5% da população de mulheres na Bahia e, em relação ao nível de escolaridade, estão mais representadas no nível fundamental e médio e, em relação ao nível superior, as mulheres brancas (29,9%) superam quase quatro vezes mais (3,9) quando comparadas às negras (7,6%) (p< 0,000). Em relação às características do acesso e utilização dos serviços de saúde, e no que se refere à cobertura de plano de saúde, as mulheres negras, apenas 18,5% tem cobertura e as brancas chegam a 30,2% o quantitativo das que tem plano de saúde (p< 0,000). E sobre o acesso aos serviços preventivos de saúde e a raça/cor foi observado que, para o acesso considerado bom, as mulheres brancas representam 15,4%, enquanto que as mulheres negras 7,9% e, para o acesso regular, o indicador é representado por mais de 10% das mulheres (11,8% brancas; 13,6% negras) (p< 0,000).No entanto, no que se refere ao acesso ruim as mulheres tem uma alta concentração, chegando a mais de 70% (72,8% brancas; 78,6% negras). O estudo evidenciou que, em alguma medida, as desigualdades raciais gerada pelo racismo surgem como barreiras no acesso aos serviços preventivos de saúde para as mulheres negras. E que as desigualdades raciais são determinantes sociais de saúde, que impactam nas condições de vida, no processo de saúde-doença e no acesso aos serviços preventivos de saúde. (AU)


Assuntos
Humanos , Feminino , Serviços Preventivos de Saúde , Saúde da Mulher , Racismo , Identidade de Gênero , Acessibilidade aos Serviços de Saúde , População Negra , População Branca
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