Disproportionate Impact of Coronavirus Disease 2019 (COVID-19) Among Pregnant and Postpartum Black Women in Brazil Through Structural Racism Lens

Explaining covid-19 performance: what factors might predict national responses?

“…29 In Brazil, social inequities and structural racism placed pregnant and postpartum black women at higher risk of death. 30 Everywhere, marginalised people and those living in precarious situations tend to fall through the cracks in the social safety nets, find it harder to isolate when required, and cannot avoid settings where the risks of infection are high. Marginalised people also face the risk of losing their jobs and housing, fail to qualify for social security, and face food insecurity.…”

Maternal mortality by COVID-19 in Brazil

“…Maternal deaths seem, in fact, more frequent in low and middle income countries and would result from serious health system failures allied to the social determinants of the health-disease process. This has also been seen in other Latin American countries, [10][11][12][13][14][15] especially Mexico, which maintains an efficient reporting system. 20 The studies of a group also show a higher frequency of death in the puerperal period 11,12 and suggest that the higher mortality in pregnant women in Brazil is due to chronic problems of women's health care in the country, such as insufficient resources, low prenatal quality, available beds less than the real necessity, difficulty to access the services, racial disparities and obstetric violence.…”

“…This study found that black women were hospitalized in worse conditions, such as higher prevalence of dyspnea and lower oxygen saturation, in addition to a higher rate of intensive care unit (ICU) admission and assisted mechanical ventilation, and a risk of death almost twice as high in black women when compared to white women. 13 This enormous social, racial and gender inequality was also described in the United States of America (USA), mainly related to the access to health services. 16 It is interesting to compare the results of Brazilian studies with international studies, because finally, after the pandemic spread and reached more pregnant women around the world, American studies such as the Centers for Diseases Control and Prevention (CDC), 17 the Swedish study 18 and studies in Belgium and France 19 began to demonstrate increased risk of complications and ICU admission, and greater need for mechanical ventilation for pregnant women, but not maternal death.…”

“…9 The Brazilian Group of Studies on COVID-19 and Pregnancy has been publishing since April several articles in the national literature alerting the risk of maternal death by COVID-19. [10][11][12][13][14][15] In a widely disseminated study analyzing data from the spreadsheet of the Sistema de Informações de Vigilância Epidemiológica da Gripe (SIVEP Gripe) (Influenza Epidemiological Surveillance Information System), available from the Ministry of Health found that 978 pregnant women and puerperal were diagnosed with Severe Acute Respiratory Syndrome (SARS) by COVID-19 and of these 124 died (lethality rate of 12.7%). Although an association of death with co-morbidities such as obesity, diabetes and cardiovascular diseases had been found, what attracted more attention in this study were the serious failures of care: 15% of the women had not received any type of ventilatory assistance, 28% did not have access to an intensive care unit (ICU) bed and 36% were not intubated or received mechanical ventilation.…”

“…The policy of the Ministry of Health has also been criticized, which so far has not implemented universal testing for admission to maternity hospitals using molecular tests (RT-PCR). [10][11][12][13][14][15] It is also important to highlight the speed of transmission in the world and the consequent increase in the maternal death rate in Brazil. By September 27, 2020 there were 32,925.668 million people infected and 995,352 deaths worldwide by COVID-19, nine months after the first reported case.…”