0330/2020 - Desigualdade racial nas boas práticas e intervenções obstétricas no parto e nascimento em maternidades da rede cegonha Racial inequality in good practices and obstetric interventions of labor and birth care in Rede Cegonha
O objetivo do presente estudo foi avaliar desigualdade racial na atenção ao parto e nascimento na Rede Cegonha utilizando indicadores de boas práticas e intervenções obstétricas. Desigualdade racial, mensurada pelo efeito total da raça/cor no modelo sem ajuste, foi detectada em muitos indicadores. A persistência do efeito direto, após ajuste para os mediadores idade, escolaridade, paridade, hospital de alto risco e região geográfica, sugere discriminação racial contra as pretas, que tiveram menos partograma preenchido (RP 0,88; IC 95% 0,80-0,95). Comparadas às brancas, as pretas ficaram menos em litotomia (RP 0,93; IC95% 0,89-0,98), realizaram menos episiotomia (RP 0,81; IC95% 0,68-0,96) e tiveram menos dor na sutura da episiotomia (RP 0,66; IC95% 0,51-0,87), sugerindo que boas práticas estariam sendo mais realizadas nas pretas. Entretanto, pelo modelo intervencionista de assistência, ainda adotado por muitos profissionais, essas práticas são de rotina e a menor realização delas nas pretas seria melhor interpretada como evidência de discriminação racial a essas mulheres. Para outros desfechos, o efeito da raça/cor desapareceu após o ajuste para mediadores, sugerindo atenuação ou desaparecimento do efeito da cor da pele em algumas práticas/intervenções na assistência ao parto e nascimento.
Palavras-chave:
Racismo; Parto; Nascimento Vivo
Abstract:
The aim of this study was to evaluate the racial inequality on delivery and birth care at Rede Cegonha (Stork Network) using good practice indicators and obstetrical interventions. Racial inequality, measured by the total effect of race/color in the crude model, was seen in many indicators. The persistency of the direct effect, after adjustment on mediators, such as: age, education, parity, high risk hospital and geographic macroregions, suggests racial discrimination against black women, that had less partogram filling (RP 0.88; IC 95% 0.80 – 0.95). When compared to white women, black women were less in the position of lithotomy (RP 0.93; IC 95% 0.89 – 0.98), reported less episiotomy (RP 0.81; IC 95% 0.68 – 0.96) and had less pain on episiotomy suture (RP 0.66; IC 95% 0.51 – 0.87), suggesting that good practice were being done more in black women. However, according to the interventionist assistance model, still adopted by many professionals, these practices are routine, and lower achievement in black women would be better interpreted as evidence of racial discrimination against these women. For other outcomes, the effect of race/color disappeared after mediators’ adjustment, suggesting mitigation or disappearance of the effect skin color in some practices/interventions on delivery and birth care.
Racial inequality in good practices and obstetric interventions of labor and birth care in Rede Cegonha
Resumo (abstract):
The aim of this study was to evaluate the racial inequality on delivery and birth care at Rede Cegonha (Stork Network) using good practice indicators and obstetrical interventions. Racial inequality, measured by the total effect of race/color in the crude model, was seen in many indicators. The persistency of the direct effect, after adjustment on mediators, such as: age, education, parity, high risk hospital and geographic macroregions, suggests racial discrimination against black women, that had less partogram filling (RP 0.88; IC 95% 0.80 – 0.95). When compared to white women, black women were less in the position of lithotomy (RP 0.93; IC 95% 0.89 – 0.98), reported less episiotomy (RP 0.81; IC 95% 0.68 – 0.96) and had less pain on episiotomy suture (RP 0.66; IC 95% 0.51 – 0.87), suggesting that good practice were being done more in black women. However, according to the interventionist assistance model, still adopted by many professionals, these practices are routine, and lower achievement in black women would be better interpreted as evidence of racial discrimination against these women. For other outcomes, the effect of race/color disappeared after mediators’ adjustment, suggesting mitigation or disappearance of the effect skin color in some practices/interventions on delivery and birth care.
Alves, M.T.S.S.B, Chagas, D. C., Santos, A.M, Simões, V.M.F, Ayres, B.V.S, Santos, G.L, Silva, A.A.M. Desigualdade racial nas boas práticas e intervenções obstétricas no parto e nascimento em maternidades da rede cegonha. Cien Saude Colet [periódico na internet] (2020/Nov). [Citado em 05/11/2024].
Está disponível em: http://cienciaesaudecoletiva.com.br/artigos/desigualdade-racial-nas-boas-praticas-e-intervencoes-obstetricas-no-parto-e-nascimento-em-maternidades-da-rede-cegonha/17812?id=17812
