Ending racial inequality would prevent part of neonatal deaths in Brazil

"A considerable part of neonatal deaths and negative outcomes among newborns could be avoided if there were no racial inequalities in Brazil". This is what the research team at the Center for Data and Knowledge Integration for Health (Cidacs/Fiocruz Bahia) says. Published in the journal The Lancet Regional Health - Americas, the study investigates the consequences of racism suffered by pregnant women on their children and says that, if there was no racial inequality, approximately 12% of neonatal deaths – just over 12,000 deaths of children up to 7 days of age – could have been avoided.

On November 20th, the Fiocruz Moorish Castle was illuminated in the colors of the African Union, in tribute to Black Consciousness Day (photo: Peter Ilicciev)

To reach this conclusion, the researchers analyzed the occurrence of four negative outcomes among newborns: early neonatal mortality, prematurity, low birth weight and children born small for gestational age (defined by the acronym SGA). The research also estimated that 1.7% of premature births, 11% of cases of SGA and 7% of cases of low birth weight could also be prevented.

"People made vulnerable by racism have worse living conditions than white people, resulting in lower levels of education and access to worse jobs," says Poliana Rebouças, associate researcher at Cidacs/Fiocruz Bahia and one of the responsible for the study. According to her, the consequence is that these people are subjected to adverse physical effects and unfavorable economic and social contexts, which can affect access to health services and result in these inequalities in birth outcomes.

Racism and inequality

The study used databases from the Live Birth Information System (SINASC) and the Mortality Information System (SIM), analyzing data from just over 23 million births between 2012 and 2019. The racial identification of the pregnant person was used as an indicator of the presence of racism, being understood that the differences in negative outcomes between children are due to social inequalities, as race is a socially constructed category.

"We use maternal racial identification as an indication of racism in the person's life, recognizing that the relationship between race/color and negative outcomes in children's lives is due to social differences, not biological differences," Poliana stresses.

The analysis also took into account the level of maternal education – seen as an indicator of socioeconomic conditions – to assess how racism cuts across different socioeconomic groups. The result revealed that the lower the mother's level of education, the greater the chance of negative outcomes for her children.

Among indigenous pregnant women with fewer years of education, the analysis adjusted for the factor 'level of education' points to a risk of 30% of neonatal death, 25% of prematurity, 22% of low birth weight and 27% of small for gestational age births. Eliminating racial inequalities could reduce the occurrence of neonatal death, low birth weight and SGA among their children by more than 60%, and reduce premature births by 28%.

Among brown and black women, the reduction could exceed 40% in cases of neonatal death, low birth weight and SGA, and 18% in premature births. Even so, the analysis shows that even among women from minority racial groups with higher levels of education, racial inequalities persist in the health outcomes of their children.

The data further shows that the majority of younger pregnant women, had lower levels of education and were less likely to attend prenatal care appointments were black and brown. Indigenous and black pregnant women had the highest proportions of occurrences of the negative outcomes analyzed.

Recommendations

According to Poliana, these findings add to other evidence of how racial inequality affects women's health. "If we understand that these outcomes occur due to conditions suffered by pregnant women – such as the lack of access to prenatal care appointments – it becomes clear that racial inequality influences a person's entire life, since before birth," she explains.

The effects of racial inequality observed from the beginning of life demonstrate the need for action to reduce the impact of racism on maternal and child health. According to the research team, a continuous effort and policies that address institutional racism are needed to tackle the issues highlighted in the study.

"Even with all the historical pressure exerted by social movements in the fight for health equity, there is still a lack of incentive for public policies aimed at tackling inequality," Poliana adds.