Racial discrimination and health: health professionals’ actions in providing care women in the induced abortion process

Ferreira, Aldo Pacheco; Cardoso, Gisela Cordeiro Pereira; Nichele, Cíntia da Silva Telles; Girianelli, Vania Reis; Silva, Angélica Baptista; Godinho, Marluce Rodrigues

doi:10.1590/1413-812320212610.10532021

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ARTICLE • Ciênc. saúde coletiva 26 (10) • Oct 2021 • https://doi.org/10.1590/1413-812320212610.10532021 copy

Racial discrimination and health: health professionals’ actions in providing care women in the induced abortion process

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This paper aims to evaluate the racial inequalities in the care provided by health professionals concerning induced abortion. This systematic review study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) model, based on the following bases: Brazilian Virtual Health Library (BVS), Scientific Electronic Library Online (SciELO), National Library of Medicine, and National Institutes of Health (PubMed), Science Direct, Capes periodicals portal, with the descriptors: “racism OR social discrimination AND abortion, induced AND health personnel OR comprehensive health care OR delivery of health care OR human rights”, selected via the DeCS and Medical Subject Heading (MeSH). Eighteen papers published between 2005 and 2020 in national and international literature were analyzed following the inclusion and exclusion criteria. Most studies found a significant relationship between racial discrimination and institutional violence, including access and quality of care for patients undergoing an induced abortion. Racial discrimination is a significant risk factor for adverse care outcomes.

Key words:
Abortion; Health professional; Racial discrimination; Emergency medical services; Human Rights

Data	Definition
Availability	Must have a sufficient amount of functioning public health facilities, goods and services, and programs
Accessibility	Health facilities, goods, and services must be accessible (i.e., physical, financial, and information access) to everyone within the State’s jurisdiction, without discrimination
Acceptability	The social and cultural distance between health systems and their users determines acceptability. All healthcare facilities, goods, and services must respect medical ethics and be culturally appropriate and sensitive to gender and age. They must also be designed to confidentially respect and improve the health status of the individuals involved
Quality	Health facilities, goods, and services must be scientifically and medically approved and of satisfactory quality

Author (year)	Journal	Study location	Methodological Approach	Sample	Objective
Motta³⁷37 Motta IS. A relação interpessoal entre profissionais de saúde e a mulher em abortamento incompleto: "o olhar da mulher". Rev Br Saude Materno Infantil 2005; 5(2):219-228. (2005)	Rev. Bras. Saude Mater. Infant.	Rio Grande do Norte (RN), Brazil	Qualitative exploratory-descriptive research. Semi-structured interviews and data from medical records	17 women aged 15 to 30 years	Evaluate the qualitative characteristics of the interpersonal relationship between health professionals and women with incomplete abortion.
Bispo and Souza³⁸38 Bispo CDB, Souza VLC. Violência institucional sofrida por mulheres internadas em processo de abortamento. Rev Baiana Enferm 2007; 21(1):19-30. (2007)	Rev. Baiana de Enferm.	Feira de Santana (BA), Brazil	Qualitative research. Semi-structured interview	9 women (brown and black) aged 19 to 39 years	To analyze the respondent’s perception of institutional violence.
Gesteira et al.³⁹39 Gesteira SMA, Diniz NMF, Oliveira EM. Assistência à mulher em processo de abortamento provocado: discurso de profissionais de enfermagem. Acta Paulista Enferm 2008; 21(3):449-453. (2008)	Acta Paul. Enferm.	Salvador (BA), Brazil	Qualitative research, detailed case study, content analysis, focus group	05 nurses and 04 nursing assistants	To observe the health problem that involves women in the process of induced abortion. The discourse of nursing staff professionals regarding the care provided to women was analyzed to change care for these women towards humanization.
Harries et al.⁴⁰40 Harries J, Stinson K, Orner P. Health care providers' attitudes towards termination of pregnancy: A qualitative study in South Africa. BMC Public Health 2009; 9:296. (2009)	BMC Public Health	Western Cape (South Africa)	Qualitative research. Focus group	Thirty-four health professionals involved in a range of aspects of providing abortion services.	Despite changes in abortion legislation in South Africa in 1996, barriers to women’s access to health services still exist, including opposition by professionals, compounded by the lack of trained and willing abortion professionals.
Aguiar and d’Oliveira⁴¹41 Aguiar JM, d'Oliveira AFPL. Violência institucional em maternidades públicas sob a ótica das usuárias. Interface (Botucatu) 2011; 15(36):79-92. (2011)	Interface (Botucatu)	São Paulo (SP), Brazil	Qualitative research. Semi-structured interview	21 women above 18 years	To present and discuss data from a survey on institutional violence in public maternity hospitals for women with an induced abortion situation.
Benute et al.⁴²42 Benute GRG, Nonnenmacher D, Nomura RMY, Lucia MCS, Zugaib M. Influência da percepção dos profissionais quanto ao aborto provocado na atenção à saúde da mulher. Rev Br Ginecol Obstetr 2012; 34(2):69-73. (2012)	Rev. Bras. Ginecologia e Obstetrícia	São Paulo (SP), Brazil	Quantitative research, cross-sectional study. Self-applicable questionnaire	Professionals (n=119) working in the Department of Obstetrics, University Hospital, and the public hospital in the outskirts of São Paulo.	To verify the knowledge about Brazilian legislation and the perception of professionals working in obstetrics related to induced abortion.
Aguiar et al.⁴³43 Aguiar JM, d'Oliveira AFPL, Schraiber LB. Violência institucional, autoridade médica e poder nas maternidades sob a ótica dos profissionais de saúde. Cad Saude Publica 2013; 29(11):2287-2296. (2013)	Cad. Saúde Pública	São Paulo (SP), Brazil	Qualitative research. Semi-structured interview	Eighteen health professionals working in public and private networks, including obstetricians, nurses, and nursing technicians.	To analyze institutional violence, medical authority, and power in maternity hospitals from the perspective of health professionals in caring for women undergoing an induced abortion.
Carneiro et al.⁴⁴44 Carneiro MF, Iriart JAB, Menezes GMS. "Largada sozinha, mas tudo bem": paradoxos da experiência de mulheres na hospitalização por abortamento provocado em Salvador, Bahia, Brasil. Interface (Botucatu) 2013; 17(45):405-418. (2013)	Interface (Botucatu)	Salvador (BA), Brazil	Qualitative research. Semi-structured interview. Content analysis	Nineteen women aged over 18 years about the experience at different stages of hospitalization and evaluating the care received.	To understand the experience of women hospitalized for an abortion caused in three public hospitals in Salvador, Bahia, from the path and interactions they establish with professionals and other users.
Lemos and Russo⁴⁵45 Lemos A, Russo JA. Profissionais de saúde e o aborto: o dito e o não dito em uma capacitação profissional em saúde. Interface (Botucatu) 2014; 18(49):301-312. (2014)	Interface (Botucatu)	Rio de Janeiro (RJ), Brazil	Qualitative and ethnographic approach, using participatory observation	11 health professionals	To analyze the view of health professionals about induced abortion and its relationship with professional practice.
Nieminen et al.⁴⁶46 Nieminen P, Lappalainen S, Ristimäki P, Myllykangas M, Mustonen AM. Opinions on conscientious objection to induced abortion among Finnish medical and nursing students and professionals. BMC Med Ethics 2015; 16:17. (2015)	BMC Medical Ethics	Kuopio University Hospital (Finland)	Quantitative research. Cross-sectional study. Self-applicable questionnaire	548 medical and nursing students and professionals	To study how Finnish medical and nursing students and professionals assess conscientious objection both per se (whether it should be allowed or not) and as a complex process, as are the professionals and instances for which conscientious objection can be allowed.
Aniteye et al.⁴⁷47 Aniteye P, O'Brien B, Mayhew SH. Stigmatized by association: challenges for abortion service providers in Ghana. BMC Health Serv Res 2016; 16:486. (2016)	BMC Health Services Research	Accra (Ghana)	Qualitative research. Semi-structured interview	Three hospitals and five health centers. Participants (n=36) consisted of an obstetrician/gynecologist, obstetric nurses, and pharmacists.	To explore the challenges in providing obstetric care to induced abortion patients, avoiding racism and institutional violence by health professionals.
Mccallum et al.⁴⁸48 Mccallum C, Menezes G, Reis AP. O dilema de uma prática: experiências de aborto em uma maternidade pública de Salvador, Bahia. Hist Cien Saude-Manguinhos 2016; 23(1):56. (2016)	Hist. Ciên. Saúde-Manguinhos	Salvador (BA), Brazil	Qualitative research. Participatory observation	One hundred thirteen professionals, including doctors, nursing assistants and technicians, psychologists, social workers, and nutritionists.	To analyze the hospital experience of women in the face of voluntary interruption and the viewpoint of health professionals, evaluating how the institution structures abortion care and the symbolization processes imbricated to it that can profoundly affect women’s experiences.
Chavkin et al.⁴⁹49 Chavkin W, Swerdlow L, Fifield J. Regulation of conscientious objection to abortion: An international comparative multiple-case study. Health Hum Rights 2017; 19(1):55-68. (2017)	Health and Human Rights	England, Italy, Norway, Portugal	Qualitative research. Comparative multiple case study that triangulates multiple data sources, including interviews with key stakeholders from all sides of the debate.	Fifty-four hospital managers from countries involved in research on care for women in abortion situations.	To investigate the effectiveness and acceptability of laws and policies that allow conscientious objection (abuse of professional power) and guarantee access for women in abortion situations.
Madeiro and Rufino⁵⁰50 Madeiro AP, Rufino AC. Maus-tratos e discriminação na assistência ao aborto provocado: a percepção das mulheres em Teresina, Piauí, Brasil. Cien Saude Colet 2017; 22(8):2771-2780. (2017)	Ciência & Saúde Coletiva	Teresina (PI), Brazil	Qualitative research. Semi-structured interview	Seventy-eight women admitted to a public hospital of reference in Teresina due to induced abortion complications.	To identify the magnitude and impact of institutional violence on care for induced abortion complications.
Ishoso et al.⁵¹51 Ishoso DK, Tshefu AK, Coppieters Y. Analysis of induced abortion-related complications in women admitted to referral health facilities in Kinshasa, Democratic Republic of the Congo. PLoS One 2018; 13(8):e0203186. (2018)	PLoS ONE	Kinshasa (Democratic Republic of Congo)	Quantitative research. Descriptive cross-sectional study	843 obstetric and gynecological patients admitted as emergency cases	To analyze the extent and characteristics of induced abortion-related complications, including length of hospital stay, the mortality rate from induced abortion complications and its characteristics, and deaths occurring after two hospitalization days.
Orpin et al.⁵²52 Orpin J, Puthussery S, Burden B. Healthcare providers' perspectives of disrespect and abuse in maternity care facilities in Nigeria: a qualitative study. Int J Public Health 2019; 64:1291-1299. (2019)	Benue (Nigeria)	Qualitative research. Semi-structured interview	16 health professionals	To examine how health professionals perceive the disrespect and abuse to women undergoing an abortion, emphasizing induced abortion during care in Benue state, Nigeria.	Examinar como os profissionais de saúde percebem o desrespeito e abuso às mulheres em situação de aborto, com destaque ao aborto provocado, durante o atendimento no estado de Benue, Nigéria.
Dorr and Dietz⁵³53 Dorr NM, Dietz G. Racism against Totonaco women in Veracruz: Intercultural competences for health professionals are necessary. PLoS One 2020; 15(1):e0227149.(2020)	PLoS ONE	Veracruz (Mexico)	Qualitative research. Participatory observation	60 health professionals	To analyze the care of patients undergoing abortion care concerning the cultural, individual, and institutional racism.
Goes et al.⁵⁴54 Goes EF, Menezes GMS, Almeida MCC, Araújo TVB, Alves SV, Alves MTSSB, Aquino EML. Vulnerabilidade racial e barreiras individuais de mulheres em busca do primeiro atendimento pós-aborto. Cad Saude Publica 2020; 36(Supl. 1):e00189618. (2020)	Research performed in Salvador (Bahia), Recife (Pernambuco) and São Luís (Maranhão), Brazil	Quantitative research. Analytical cross-sectional study	2.640 users admitted to public hospitals.	To analyze the factors related to individual barriers in searching for the first post-abortion care by ethnicity/skin color.	Analisar os fatores relacionados às barreiras individuais na busca do primeiro atendimento pós-aborto segundo raça/cor.

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[1] Collaborations

AP Ferreira worked on the design, research, methodology, and final writing. MR Godinho and CST Nichele worked on the research, methodology, and final writing. VR Girianelli worked on the methodology and final writing. AB Silva and GCP Cardoso worked on the conception and final writing.