Centro de Ciências da Saúde, Universidade Federal do Maranhão. R. Barão de Itapary 155, Centro. 65020-070 São Luís MA Brasil.
Escola Nacional de Saúde Pública Sérgio Arouca, Fiocruz. Rio de Janeiro RJ Brasil.
Cien Saude Colet. 2021 Mar;26(3):837-846. doi: 10.1590/1413-81232021263.38982020. Epub 2020 Oct 28.
This study aimed to evaluate the racial inequality on childbirth care at the Rede Cegonha (Stork Network) using obstetric good practice and interventions indicators. Racial inequality, measured by the total effect of ethnicity/skin color in the crude model, was seen in many indicators. After adjusting for mediators, such as age, schooling, parity, high-risk hospital, and geographic macro-regions, the persistent direct effect suggests racial discrimination against black women with lower partograph completion (PR 0.88; 95% CI 0.80-0.95). Black women stayed less in lithotomy (PR 0.93; 95% CI 0.89-0.98), performed less episiotomy (PR 0.81; 95% CI 0.68 - 0.96), and had less episiotomy suturing pain (PR 0.66; 95% CI 0.51 - 0.87) when compared to white women, suggesting more good practice applied to black women. However, according to the interventionist care model still adopted by many professionals, these practices are routine, and lower achievement in black women would be better interpreted as evidence of racial discrimination against these women. For other outcomes, the ethnicity/skin color effect disappeared after adjusting for mediators, suggesting mitigation or disappearance of the skin color effect in some practices/interventions in childbirth.
本研究旨在利用产科良好实践和干预指标评估 Rede Cegonha（鹳鸟网络）的分娩护理中的种族不平等现象。种族不平等，通过种族/肤色在原始模型中的总效应来衡量，在许多指标中都存在。在调整了年龄、教育程度、产次、高危医院和地理大区等中介因素后，持续的直接效应表明，黑人妇女在产程图完成方面受到歧视，其完成率较低（PR 0.88；95%CI 0.80-0.95）。与白人妇女相比，黑人妇女采用截石位的时间更短（PR 0.93；95%CI 0.89-0.98），会阴切开术更少（PR 0.81；95%CI 0.68 - 0.96），会阴切开缝合疼痛也更少（PR 0.66；95%CI 0.51 - 0.87），这表明对黑人妇女实施了更多的良好实践。然而，根据许多专业人士仍然采用的干预主义护理模式，这些做法是常规的，黑人妇女的低成就更好地解释为对这些妇女的种族歧视的证据。对于其他结果，在调整了中介因素后，种族/肤色的影响消失了，这表明在分娩过程中的一些实践/干预中，肤色的影响得到了缓解或消失。
