NEWS
Center Challenges Brazil’s Record On Maternal Mortality
[December 7, 2007]
On November 30, the Center, with Brazilian partner Advocaci, filed Alyne da Silva Pimentel v. Brazil, the first maternal mortality case to be brought before the UN’s Committee on the Elimination of Discrimination Against Women (CEDAW).
Alyne, a 28-year-old Afro-Brazilian woman, died of complications resulting from pregnancy after her local health center misdiagnosed her symptoms and delayed providing her with emergency care. Brazil’s maternal mortality rates are disproportionately high for a country of its economic status, and the chances of dying in pregnancy and childbirth are greatest among indigenous, low-income, and Afro-descendant women such as Alyne. The Center's petition argues that Brazil’s government violated Alyne's rights to life, health, and legal redress, all of which are guaranteed both by Brazil’s constitution and international human rights treaties, including CEDAW.
"Alyne's story epitomizes Brazil's violation of women's human rights and failure to prevent women from dying of causes that, by the government’s own admission, are avoidable," said Lilian Sepúlveda, the Center’s Legal Adviser for Latin America and the Caribbean. "We filed this case to demand that Brazil make the necessary reforms to its public health system—and save thousands of women’s lives."
Maternal Mortality In Brazil: Some Facts
I. Overview
- According to the World Health Organization (WHO), in 2005 an estimated 536,000 women died from pregnancy- and childbirth-related complications worldwide.
- In Latin America and the Caribbean, 15,000 women die annually.
- Brazil accounts for nearly a quarter of those deaths with 4,100 women dying every year.
- In its 2005 report, the United Nations Development Assistance Framework Common Country Assessment referred to the "large disparities in health care funding by region" and specifically noted that Brazil's maternal mortality rates are "considerably higher than those of countries with lesser levels of economic development, and are generally conceded to be unacceptable."
- Demographically, Brazil's maternal mortality rates are much higher in the North and Northeast which contain a greater share of poverty and larger rural populations than the rest of the country.
A. How Race Factors In
- Racial dynamics play an important role in the country's high incidence of maternal mortality.
- Afro-descendants account for 61% of the country’s poor.
- By Brazil's own admission, "poverty is concentrated on black or Afro-descending women." Women of African descent and women who are indigenous, poor and single women living in Brazil's most impoverished regions are disproportionately affected by maternal mortality. Pregnancy-related death rates are higher among black women in all age groups. For instance, in the state of Paraná, black women from that state are seven times more likely than other women to die from pregnancy- and childbirth-related causes. However, the highest rates occur in the Northern and Northeast regions of the country, particularly in rural areas, where a majority of Brazil's Afro-descendant population lives.
B. Prevention at a Low Cost
Despite high incidence of maternal mortality worldwide, the majority of maternal deaths are easily preventable and at a low cost. In fact, most maternal deaths are caused by infections, hemorrhage and unsafe abortion, all of which could be managed by health care workers with midwifery skills.
II. How Brazil Is Measuring Up
A. Failure to Prioritize Pregnancy-Related Deaths
While Brazil accounts for over a quarter of all maternal deaths in Latin America, the government has yet to treat maternal mortality with any sense of urgency.
- In 2000, 189 countries—including Brazil—made a commitment to reduce pregnancy-related deaths as part of their development goals.
- Almost eight years later, despite the high incidence of pregnancy-related deaths, the government has failed to deliver on its commitments.
By contrast, in its recent efforts to prevent the spread of HIV/AIDS, Brazil has been hailed as a global leader. Its progress has been attributed to the country's "commitment to a proactive, aggressive agenda—based on a strategy that encompasses prevention . . . , treatment . . . , and the promotion of human rights of people living with the virus." Despite its progress in reducing HIV transmission, poverty, and infant mortality, the government has failed to similarly reduce the incidence of maternal mortality.
In Brazil's Multi-Year Plan for 2004-07, it identified seven priorities in the area of health; however, not one of those priorities was to reduce maternal mortality. Moreover, in response to a recent survey conducted by the Economic Commission for Latin America and the Caribbean that analyzed the state of health in 17 countries, Brazil made no reference to maternal health as one of its top three health priorities. But Guatemala and Nicaragua, countries with maternal mortality ratios nearly identical to Brazil, did list maternal and child mortality as their top health concern.
B. Inadequacies in Brazil's Health-Care System
While Brazil has introduced various initiatives to improve maternal health, the World Bank noted flaws in some of these plans and predicted that they were not likely to significantly reduce maternal deaths. Experts have also criticized the country's health-care system as a whole.
For example, Brazil's expenditure patterns in health care have been deemed inequitable because they "continue to favor the regions that are better off and healthier." The systems for referring women to hospitals are also purported to "function so poorly, [that] pregnant women sometimes scramble to find an available hospital bed when they enter labor." In adddition, they are ineffective because medical records on prenatal care are not linked to treatment at the time of delivery, thus compromising physicians' ability to diagnose and rapidly treat patients in emergency situations.
Government efforts to promote maternal health are also likely thwarted by existing disparities in access to Brazil's health care. As noted above, there are significant disparities based on race that affect access to, and quality of, health-care services. Severe inequalities also exist based on geographical location and income level.
Brazil has the capability and resources to reduce the country's high incidence of pregnancy-related deaths. Its failure to do so has detrimental consequences for a large percentage of the country's women, children and families.
PUBLICATIONS
Reports
Read the Brazil chapter from Women of the World: Laws and Policies Affecting Their Reproductive Lives -- Latin America and the Caribbean
Mas allá del derecho. Justicia y género en América Latina
(available in Spanish only). This book is the first publication of the Red Alas network, a Latin American network of law professors that aims to reform legal education in the region from a gender perspective. The Center for Reproductive Rights supports and is a part of this network.
Bodies on Trial: Reproductive Rights in Latin American Courts
Briefing Papers
Shadow Reports
Organizations like the Center for Reproductive Rights and its partners play an essential role in providing credible and reliable independent information to international human rights treaty monitoring bodies regarding the legal status and real-life situation of women and the efforts being made by governments to comply with human rights treaties. Shadow reports work to supplement, or "shadow," governments' reports on human rights issues by calling attention to their strides, as well as their setbacks.
Regional Partner Organizations
