Maternal health is drastically affected by systemic racism, not just in the United States but all around the world. In Brazil, data from the Ministry of Health indicates that while maternal mortality decreased by 55 percent from 1990 to 2013, it has since increased annually, with more than 64 recorded deaths per 100,000 children born in 2017. Despite the overall improvement for all mothers, 2018 data from the Ministry of Health shows that more than 54 percent of all maternal deaths are among Black women. In Brazil, Black women have twice the chance of dying during pregnancy and childbirth than white women.

Black scholars and activists have shown the effects of racism in health care in Brazil, particularly in the inequities in maternal outcomes. At a maternal-health level, systemic racism shows up in many ways: Black women receive less anesthesia during birth, are subject to discriminatory and obstetric violence through microaggressions by health-care workers, and have less access to prenatal care. The intersection of classism, poverty, and racism contributes to why women are dying in childbirth, in situations that are mostly preventable.

In 2013, Brazil launched an agenda to address systemic racism in the public health-care system. Its Política Nacional de Saúde Integral da População Negra (National Policy for Health and Healthcare for the Black Population) promotes policies that formally categorize race and ethnicity, with the goal of documenting disparities in health care and instantiating race-conscious health-care programs.

But while policy is important, translating it into hospital protocol and practice is very difficult. Hospitals have a multitude of priorities and demands from the national and/or state governments, and therefore must choose to act on policy priorities set by policy changes. Furthermore, the lack of understanding of structural racism at the interpersonal and institutional levels has affected how quickly hospitals enact this policy. American grassroots-organizational scholars Kenneth Jones and Tema Okun’s workbook on white supremacy culture enumerates the factors that counteract the prioritization of policy to address systemic racism: paternalism, individualism, and power hoarding by individuals with decision-making authority.

Read the full article about addressing systemic racism in maternity care by Santiago Nariño and Jussara Francisca de Assis dos Santos at Stanford Social Innovation Review.