Abstract
Social inequalities in Brazil are reflected in women's search for abortion care, when they face individual, social, and structural barriers and are exposed to situations of vulnerability. Black women are the most heavily exposed to these barriers, from the search for the service to the care itself. The study aimed to analyze factors related to individual barriers in the search for first post-abortion care according to race/color. The study was conducted in Salvador (Bahia State), Recife, (Pernambuco State) and São Luís (Maranhão State), Brazil, with 2,640 patients admitted to public hospitals. Logistic regression was performed to analyze differences according to race/color (white, brown, and black), with "no individual barriers in the search for first care" as the reference category in the dependent variable. Of the women interviewed, 35.7% were black, 53.3% brown, and 11% white. Black women had less schooling, fewer children, and reported more induced abortions (31.1%) and more second-trimester abortions (15.4%). Black women reported more individual barriers in the search for first care (32% vs. 28% in brown women and 20.3% in whites), such as fear of being mistreated and lack of money for transportation. Regression analysis confirmed the association between black and brown race/color and individual barriers in the search for post-abortion care, even after adjusting for all the selected variables. The results confirmed the situation of vulnerability for black women and brown women in Brazil. Racial discrimination in health services and abortion-related stigma can act simultaneously, delaying women's access to health services, a limitation that can further complicate their post-abortion condition.
Highlights
Brazil’s inequalities are reflected in women’s search for abortion care, when they experience itineraries affected by individual, social, and structural barriers that expose them to situations of vulnerability [1,2,3].Ayres et al 4 defines vulnerability as a set of individual and collective aspects related to the degree and mode of exposure to a given situation and indissociably to greater or lesser access to adequate resources
A census was conducted in 19 public hospitals in the three cities from August to December 2010, reaching all 2,804 women 18 years and older residing in the three cities and who had been hospitalized while in process of abortion or due to abortion complications, independently of the clinical condition’s severity or type of abortion
The results show the degree to which black and brown women are exposed to situations of vulnerability in the search for first post-abortion care
Summary
Ayres et al 4 defines vulnerability as a set of individual and collective aspects related to the degree and mode of exposure to a given situation and indissociably to greater or lesser access to adequate resources. The author highlights such aspects of vulnerability as poverty, racially based exclusion, gender inequalities, and generational issues 5. Black women experience disadvantages in schooling and income, live in more precarious housing, have more children and fewer steady partners, and are most often the family breadwinners [8,9,10,11] Their extreme social vulnerability definitely impacts their health and their access to services
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