Maternal Health in Brazil and the Myth of Choice
Lately, there has been a lot of talk on the feminist blogosphere about the “myth of choice,” partially inspired by Planned Parenthood’s decision last January to move away from the label “pro-choice.” Bloggers like Maegan Ortiz over at VivirLatino, have pointed out that a woman’s right to choose with regards to reproductive health is totally shaped by her experience in this world. Some women suffer from many barriers to even have an opportunity to access that “choice.” In other words, what kind of choice do you have if you are pregnant, can’t afford to keep the baby, can’t afford to pay for an abortion for the trip to the nearest out-of-state clinic and do not speak the language needed to communicate your health needs to a provider?
In light of these important conversations, I wanted to consider how this situation plays out similarly for Latinas in other parts of the Americas, namely, Brazil. In Brazil, as in the U.S., the concept of “choice” is used a lot when talking about women’s right to abortion, but what is rarely discussed is women’s right to safe, quality maternal health services. This is particularly true in Brazil, where we have both private and public health care, two systems that vary drastically in quality and availability. This, along with differences in care between rural and urban hospitals has a huge effect on the services that poor women are able to access (or opt out of). In particular, I find that the politics of Cesarean sections (c-sections) can teach us a lot about maternal health care in Brazil.
Brazil has one of the highest c-section rates in the world, with 30% of patients in public hospitals and 70% of patients in private hospitals undergoing them (Béhague 473). Just to give you some perspective, the World Health Organization estimates that the rate of medically necessary c-sections in any given population never reachs higher than 15% (Béhague 473). Rates higher than that generally indicate overusage of the procedure. Therefore, many women in Brazil are undergoing c-sections when they actually may not need them, whereas many women who do need them are not receiving them. In her study, Béhague also noted that with a decrease in income comes a decrease in Cesarean sections, suggesting that income is a barrier to accessing crucial medical technology (474 Béhague).
Some argue that the high rate of c-sections in Brazil is due to a culture that promotes the procedure. More and more women are scheduling C-sections in advance, in an effort to avoid the pain or physical changes associated with vaginal birth, and Brazilians doctors have gained attention for pressuring women into medically unnecessary C-sections (Béhague 476). Both of these situations are common–scheduling and being pressured to have a c-section–but Béhague’s research in Pelotas, Brazil also uncovered a different phenomenon: poor women seeking out medically unnecessary C-sections as a way to take control of their own birth experience. These women were responding to their situation as mostly poor women of color in public hospital settings, where they are often treated with little respect (or even suffer abuse at the hands of their doctors), receive minimal attention, and are rarely fully informed of what is happening to their bodies. In public hospitals in Brazil, women still cannot have a partner or companion with them in the delivery room, and instead are forced to go through labor with minimal attendance by medical staff. For them, getting a c-section can mean increased care and attention in an otherwise hostile care setting.
That being said, while living in a small rural town in Brazil, most of the women I spoke with were well aware of the recovery time associated with c-sections. In each interview I did, the woman told me that if she could choose, she would prefer to have a vaginal birth. Yet most of them had already had c-sections. It was easy to sense the powerlessness that these women felt as they talked about the disconnect between what they wanted, and the care they actually received. Ironically, most efforts to educate women on the benefits of vaginal birth are targeted at low-income women, even when their choice in the matter is relatively limited.
My friend’s story is a prime example: She went into the doctor before her due date for a check-up and was told that she needed to have a c-section in spite of the fact that she was not in labor, and the baby was not in distress. Afraid for her baby, and powerless to challenge what the doctor told her, she had the procedure. Her situation is not uncommon: Brazilian doctors rarely speak of women as active participants in their birth experiences, instead painting them as weak, and often unable to handle the pain of vaginal birth.
Along with the choice to have a baby in a safe medical environment, Brazilian women still grapple with the choice to terminate an unwanted pregnancy. Abortion is illegal in Brazil except in cases of rape or risk to the mother’s life, and under any other circumstances, the procedure is punishable by 1-10 years in prison (CFEMEA report). Of course, this doesn’t mean that abortions do not happen in Brazil; in fact 1 in 5 Brazilian women will have an abortion in her lifetime. But it does mean that access to abortion is strictly shaped by class and geography: most of these clinics are located in big cities, far away from the rural area I was living in. The lower a woman’s income, the poorer quality abortion she may receive (or induce on herself). This is why black women are much more likely to die of abortion-related complications than white women, and why the state I was living in, Bahia (which has the largest population of Afro-Brazilians in the country), lists abortion as its primary cause of maternal mortality. In 2008 alone, “there were 215,000 hospitalizations in [public hospitals] for complications of abortion” (Diniz et al 97). Those women that do suffer from post-abortion complications often seek out medical care in public hospitals, where they may suffer from abuse and poor treatment at the hands of care workers who disapprove of their “choice.”
To give an example of what “choice” can look like for some women in Brazil, I looked at the experience of women living in Itacaré, the town in the North of Brazil where I lived for three months (see interviews at the end of the post). Up until recently, Itacaré was a very small beach town, five hours from the nearest city, Ilhéus. It wasn’t until 1998 that a road was built cutting that drive into 1.5 hours and opening the town up to a huge flood of tourism. Itacaré is still relatively small and has limited institutional resources: there is a hospital with a maternity ward, but it is not equipped to perform c-sections. Those pregnant women who can will almost always travel outside of Itacaré to have their baby, not wanting to risk needing an emergency c-section and not having it available. This of course costs money to travel there and stay multiple days, waiting to give birth. It also means that there is an added pressure for the baby to come quickly, motivating mothers to ask for or accept c-sections instead of waiting for vaginal birth. Many of these women work full time, and undergoing a c-section can put them out of commission for months, leaving them unable to even care for themselves and their new baby for a few weeks. Other women cannot afford the travel, and simply stay in Itacaré, where they don’t have access to a potentially life-saving medical procedure.
This is not a “choice.” For many women in Brazil, safe abortions or birthing services are simply not available. Where is the choice in being pressured into an invasive surgery you don’t need? Or suffering from birth complications without a c-section to save your or your baby’s life? What “choice” includes unsafe, back alley abortions to end a pregnancy that you can’t afford?
And Brazil is not the only place this is happening. We see versions of this in the U.S. each day, with barriers like language, documentation status, or money preventing Latinas from making well-informed and safe choices for their reproductive health. We see it all around Latin America, with restrictive abortion laws, poor medical systems and inadequate cultural fluency all contributing to huge disparities in maternal health care.
It’s time that we move away from the rhetoric of “choice.” Here in the U.S., we’ve learned that Roe v. Wade did not actually do enough. Although we may have the legal right to abortion and other maternal health care, that right is being chipped away at every day through the passage of state laws which protect the fetus as a human being and the elimination of critical federal funds to organizations like Planned Parenthood. These changes impact all women, but are particularly devastating for poor migrant women of color.
Can you still be pro-choice? Yes! Be pro-choice in the legal sense, but also acknowledge what that means. Start escorting at your local abortion clinic. Become a doula, learn Spanish and be a support for women in their birth process. Donate to your local abortion fund, campaign against restrictive laws like the one in North Dakota. Stand up for a broader understanding of reproductive “choice” for all Latinas – from the right to quality, affordable and accessible health care to the right to make the best decision for one’s body detached from politics.
To learn more about Brazilian women’s experience with maternal health care, take a look at some of the interviews I conducted in Itacaré.
Works Cited
Béhague, Dominque P. “Beyond the Simple Economics of Cesarean Section Birthing: Women’s Resistance to Social Inequality.” Culture, Medicine and Psychiatry 26 (2002): 473-507. Print.
Diniz, Simone G., Ana Flavia Pires, Lucas D’Oliveira, and Sonia Lansky. “Equity and Women’s Health Services for Contraception, Abortion and Childbirth in Brazil.” Reproductive Health Matters 94.101 (2012): n. pag. Print.
Downie, Andrew. “Abortions in Brazil, Though Illegal, Are Common.” Time Magazine World. Time Magazine, 2 June 2010. Web. 21 Mar. 2013 <http://buff.ly/ZLDjlb>.
McCallum, Cecilia. “Explaining Caesarean Section in Salvador Da Bahia, Brazil.” Foundation for the Sociology of Health and Illness (2005): n. pag. Print.
Aldeia Maracanã: Indigenous Housing Rights in Pre-World Cup Rio
It’s been no secret within Brazilian media that the upcoming World Cup will have lots of positive benefits for the national economy and our country’s image on a larger global stage. However, this increased attention is also attracting some uncomfortable scrutiny of Brazil, and preparations for the cup are raising questions about who is to be included in this international celebration of Brazil’s favorite past time.
A great example of this is the struggle currently going on in Rio around the privatization and expansion of the city’s famous soccer stadium, Maracanã. In 2012, a private company took on the reform of the stadium, making plans to build a parking garage, commercial area and expanded exits, all of which would require the destruction of a few surrounding buildings. One of these buildings used to be the Indian Museum, and now houses the Services for the Protection of Indigenous Peoples.
A group of indigenous Brazilians who refer to themselves as the Aldeia Maracanã (the Maracanã Tribe) have lived in this building since 2006, and continued to occupy it after learning that the building would be appropriated by the government. They called for the building to be turned into a a Amerindian Cultural Center for to educate Brazilians and tourists on the contributions that Amerindians have made to Brazilian history and culture. As one of the protesters said: ”We want to participate in this marvelous event, but not as artists performing in the opening ceremonies, but as a living culture, with respect, dignity and the right to show our culture.” (see video)
However, on March 22, Brazilian military police invaded the building with tear gas and rubber bullets, wounding indigenous protesters and journalists there to cover the story. The protesters were removed from the premises and sent to a “provisory” space, until the government is able to construct a cultural center, which it has committed to do in a year and a half. Many of the protesters went on to occupy the new Indian Museum closer to downtown Rio, claiming that the provisory space was inadequate, and the government again removed them.
On first hearing this story, it seems confusing as to why the Aldeia Maracanã was insistent on living within the museum. Bárbara Araújo explains it well in her piece for Blogueiras Feministas, ”It’s worth remembering at this point that the occupation [of the old Amerindian Museum] was not just a cultural movement, but also a housing necessity in many cases, a result of the systematic expulsion from their territories which many indigenous groups have faced due to hydroelectric, timber, and agrobusiness projects.” Not all indians live in the forest.
Brazil often calls upon its indigenous heritage as a point of pride, using indigenous imagery within Carnaval floats, indigenous names along all its beaches (Ipanema is Tupi-Guaraní) and boasting a beautiful Amerindian museum. Yet indigenous people do not get the same treatment. So, if Rio can use Amerindian culture in a museum, it better be willing to house them. If the government is going to have indigenous people within the opening ceremonies of the World Cup, then why can’t the Indian Museum remain next to the main stadium?
This story gives us a little peak into what kind of politics of inclusion and representation will be played out during the World Cup. Who will appear within the opening ceremonies? Will those same people be allowed to attend the festivities themselves, or will the barriers to attendance increase as low-income favela inhabitants are displaced just like the Aldeia Maracanã, ticket prices rise and stadium seating shrinks?
For more on the topic, check out Araújo’s piece “Aldeia Maracanã: Dreams That Can’t Be Sold [Portuguese]“ and watch this video.
Thoughts On the Boston Marathon
When it comes to bombings, the xenophobia and racism that arises around these “acts of terrorism” can be appalling. It can make us ashamed of this country we live in that would apprehend the only Saudi man on the street, sure that he’s a terrorist. It might make us long to live somewhere else.
But it’s also nice to be reminded that though our country is by no means perfect, though not everyone is free, we are privileged in many ways. Though I might not agree with Friedman that everyone can run without fear, I like to think that this is our goal. And that’s a start.
I like to think that our country is moving forward to better ourselves in spite of senseless acts of violence. I like to think of the many people running this race with me, people who are not running just for themselves, but to support others. We are running so that those immigrants, people of color, and marginalized of society can run with us. We are running for our parents, our sisters, and friends affected by structural and street violence, by racism and discrimination. We are running.
“Americans? We run in the open on our streets — men and women, young and old, new immigrants and foreigners, in shorts not armor, with abandon and never fear, eyes always on the prize, never on all those “suspicious” bundles on the curb. In today’s world, sometimes we pay for that quintessentially American naïveté, but the benefits — living in an open society — always outweigh the costs.”
Three Pieces of Immigration News That Moved Me Today
Lately, each time I sit down at the computer to write something up, all I want to do is share some of the amazing work that other Latin@s have been putting out into the internet. And because this blog is about sharing and movement-building, I’m following my gut. Here are three things that moved me today.
1. I’ve always loved Las Cafeter@s, but this video made me want to join the band. In it, the band sings “Luna Lovers” in a dedication to Diana Blanco, a young deaf girl who’s mother and grandparents were recently apprehended by ICE. Once you’re done crying, click here to sign a petition started by the Puente Movement to get Diana’s family out of detention, then tweet to your friends that you did it using the hashtag #niunamas/#not1more
Like Las Cafeter@s say, “Yo no creo en fronteras. Yo cruzaré.”
2. In case you missed it, the Rally for Citizenship marched on the Capitol on Wednesday. Thousands of people came calling for comprehensive immigration reform with a pathway to citizenship and a stop to the deportations that are tearing families apart. Viviana Hurtado of the Wise Latinas Club created this video (gotta click, for some reason I can’t embed it) for Latina Magazine, interviewing attendees about what reform means to them.
3. You remember Erika Andiola? I wrote about her when her mother was apprehended by ICE, and together, the online community helped in pushing for her release. She was given a deferral on her deportation, to be reevaluated in a year. And Erika is still doing amazing things, like acting in beautiful music videos about the fear of deportation in immigrant lives (tell me you didn’t miss yesterday’s post!) and being interviewed by the New York Times. This woman is amazing, and I hope you’ll help me continue to support her in her work.
Arizona is the type of place where if you’re not out there, if you’re not really putting yourself out there, telling your story, you can get raided. You can get deported, and nobody knows about it. This is happening every single day.
El Hielo: A Music Video Without Papers
Grab your tissue box.
This music video, “The Ice” speaks to the constant fear of deportation that so many immigrants live with each day, unsure if they whether they will wake up with their loved ones or not. The chorus goes “ICE is loose in the streets, we never know when it will be our turn.”
The actors in the video are almost all undocumented themselves, one of them being Erika Andiola, a prominent immigrant-rights activist who used social media to stop her mother from being deported.
One of my favorite lines in the video is “Uno se queda aqui. Otro se queda aya. Eso todo por salir a trabajar.”
In a country that values labor ethic so much, how can we persecute people for leaving home to work?
This Latina on Feministing
I recently started writing for Feministing, an awesome online blog dedicated to empowering and engaging young feminists. I’m a big fan, and pretty stoked to be among so many amazing women!
Today’s post just went up with a quick round-up of immigrant women in the news, a specially designed emotional coaster for the Latina feminist. You’ll laugh, you’ll cry, you’ll rage.
Immigration and Women This Week: Mixed Emotions
1. Something to Inspire You
Yesterday the Rally for Citizenship marched on the Capitol in Washington D.C., drawing thousands of protesters and calling for comprehensive immigration reform with a pathway to citizenship. The rally had a diverse array of participants: organizations for Arab immigrants, African immigrants, allies and undocumented as well.
2. Something To Make You Angry:…..
Last week, I talked about the AP’s decision to drop the I Word, and what that means for immigrant women. It’s a pretty good review piece of why no human being is illegal.
What happens when women are “illegal”?
“…..Earlier this week, the Associated Press made the decision to drop the term “illegal immigrant” from its style guide. This is a huge step forward for immigrant rights, but the fact that such a small act is such a huge victory says a lot about how much further our country has to go to achieve even basic human rights for undocumented people. The AP may have dropped the I-Word, but plenty of major news outlets still continue to call undocumented people “illegal.”
Today, I’m thinking about undocumented women. Feministing has already established that immigration is a feminist issue, largely because it affects women, their families, their partners and communities. Undocumented women of color are targets of a myriad of racist exclusionary laws and are often hit the hardest by the so-called “War on Women.”…..”
So This Rape Was Fabricated
I don’t usually post about things specific to Santa Cruz, or even the Bay Area, where I’m from. However lately, there has been a lot going on here at UC Santa Cruz that I think will be relevant to university students around the country, and it felt important to address here on this blog. Rape culture on college campuses is alive and well, yet it’s not something we talk about enough. It seems to me that our discussions of sexual violence tend to revolve around what happens to “other” women, in “other” places, of “other” generations. In academic settings, we talk about rape as a weapon of war, domestic violence between married couples, or violence in the form of street harassment. But lately, my community has been reminded that young women, educated women and single women are also victims of sexual violence far too often.
A few weeks ago, the students of UC Santa Cruz received an email reporting a rape in a relatively well-trafficked area of campus, in broad daylight. This coincided with various other reports of violence on campus and in Santa Cruz itself, and contributed to a general sense of fear. Students held protests and spoke out about rape culture. And then, about a week later, we received an email stating that the young woman had withdrawn her accusations, claiming that the rape was fabricated.
And that was it. People began talking about how crazy this girl was for making something like that up, how could she do it, etc. etc. Not enough people asked “Why might someone decide to claim that her rape was fabricated? What could lead someone to feel uncomfortable enough or unsafe enough to withdraw charges?”
Except for my friend Cynthia. She made this wonderful video examining the school’s general response to what’s been going on. Her video is a bit long, and parts are only relevant to our campus, but I think you’ll find that a good portion of it proves important points for college rape culture in general (ex: the perception that women make false reports of rape more than other crime victims). Take a listen, won’t you?
Are you frustrated? That word doesn’t even cover how I’ve been feeling. In working on our upcoming performance of the Vagina Monologues (if you’re in the area, come check us out!) I’ve been hearing more and more stories about violence from my peers. It’s one thing to be able to quote back statistics on rape and intimate partner violence, but it’s a totally different experience hearing stories of abuse and rape from women you love and respect.
So how can we change this?
First of all, check out this piece that Everyday Feminism (where I’ve been working, whoo shoo!) wrote on How We Can Address Sexual Violence on Campuses. Two of the article’s best suggestions are to: Transform Party Culture, and Demand More Supportive and Responsive Institutions.
Then, for a wider context, read the Nation’s Ten Things to End Rape Culture. Some of my favorite points:
“Name the real problems
Here’s a tip: the right question is not, “What was she doing/wearing/saying when she was raped?” The right question is, “What made him think this is acceptable?” Sexual violence is a pervasive problem that cannot be solved by analyzing an individual situation. Learn 50 key facts about domestic violence. Here’s one: the likelihood that a woman will die a violent death increases 270% once a gun is present in the home Remember, a violent act is not a tragic event done by an individual or a group of crazies. Violence functions in society as” a means of asserting and securing power.”
Take an intersectional approach.
The numbers tell us most but not all of what we need to know. What the numbers can elide is the lived reality of women, LGBTQ people and others of us whose stories don’t make it to the headlines. Don’t forget that sex and gender are different and there are more genders than two. People who are gender-non-conforming, gender queer, trans and/or those who complicate the gender binary experience violence at disproportionate rates. Think about how a person’s income, race, sexuality, and citizenship and immigration status would impact their ability to use the criminal justice system as recourse, and come up with strategies that addressthose challenges. Move the most vulnerable from the margin to the center to develop effective solutions.
Practice real politics.
You may be crystal clear about your own rejection of rape culture, but when someone you know calls a woman a slut, approach him/her from a place of empathy. Try telling them that you know they probably meant no harm, but that you’re concerned that they may be doing some anyhow. And then explain why. And be patient: very few of us change our views in an instant. It may take time and repetition for it to start to sink in.
Don’t laugh at rape.
Most people aren’t rapists. But most rapists believe that everyone does it. What’s more, you can’t tell if you’re in the presence of a rapist. They don’t look any different from the rest of us, and may be perfectly good company. So while it might seem harmless to you to laugh at a joke that makes light of rape, your laughter could be telling an unknown rapist in your midst that you think rape is hilarious. And what’s worse: letting go of a laugh once in a while, or accidentally enabling a rapist? Your call.”
And mostly, keep spreading information like this, while working to create safe space for survivors to tell their stories.
