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

• Published in: Journal of racial and ethnic health disparities 2021-12, Vol.8 (6), p.1385-1394
• Main Authors: Freitas Goes, Emanuelle, de Souza Menezes, Greice Maria, Chagas de Almeida, Maria da Conceição, Velho Barreto-de-Araújo, Thália, Valongueiro Alves, Sandra, Seabra Soares de Britto Alves, Maria Teresa, M. L. Aquino, Estela Maria
• Format: Article
• Language: English
• Subjects: Abortion; Abortion, Induced; Access; Access to education; Barriers; Black people; Black white differences; Brazil; Chi-square test; Discrimination; Epidemiology; Female; Health care access; Health services; Health Services Accessibility; Hospitalization; Hospitals; Humans; Intersectionality; Medical personnel; Medical records; Medicine; Medicine & Public Health; Personal relationships; Pregnancy; Pregnancy complications; Professionals; Quality of Life Research; Race; Racial differences; Racial discrimination; Racism; Regression analysis; Regression models; Reproductive health; Social Inequality; Social Stigma; Social Structure; Sociodemographics; Statistical analysis; Statistical significance; Stigma; Systemic Racism; Termination; Unsafe; White people; Women; Womens health
• ISSN: 2197-3792; 2196-8837
• DOI: 10.1007/s40615-020-00900-w

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 χ 2 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.