BA maternity gives birth to an indigenous woman in the water – 04/21/2023 – Health

It was raining in Ilhéus, south of Bahia, when Ynawá, which in the Tupinambá language means “rainwater that brings abundance”, was born on the last 4th, at the natural birth center of the Hospital Materno Infantil Dr. Joachim. Her mother, Tainaçã, 20, received cassava-based food and chose to give birth in water, under the shower.

She also had the company of her mother and grandmother throughout the birth process. “I was a little afraid of suffering prejudice [por ser indígena] when it arrived to give birth. But I was welcomed from the moment I arrived, it made me feel more at ease”, says the young woman, whose name in tupinambá means “afternoon star”.

The indigenous leader Amana, 44, Tainaçã’s mother, says that births in the village happen in a similar way. “In addition to the midwife, we always have the mother and grandmother close by, helping us and passing on good energy. At no time do we leave our pregnant women alone. And we also give herbal baths from the waist down to help with contractions”, she says.

According to her, after Tainaçã’s “rescue” period, the village where they live (Acuípe de Baixo, Olivença territory) will hold a party to welcome the baby. This is the Porancy, a ritual with dance and prayers to welcome the new resident of the community.

Before leaving the maternity ward, Ynawá’s father presented the hospital staff with a headdress, a traditional accessory used by indigenous people.

The experience is part of a new proposal for specialized care for indigenous peoples that the Joaquim Sampaio hospital has adopted and which it now seeks to expand through a project sent to the Ministry of Health.

The idea is that indigenous pregnant women receive special care before, during and after childbirth, always respecting their cultural traditions. She will be able to choose, for example, to sleep in a hammock instead of a bed and eat foods that are part of her routine in the village.

In Bahia, there are 35 thousand indigenous people, of 20 ethnic groups, distributed in more than 130 villages. In the hospital, 18 natural deliveries are made monthly by women who declare themselves to be indigenous, in addition to about 90 obstetric hospitalizations (including cesarean sections and high-risk pregnancies).

According to the director of the institution, Domilene Borges Costa, special care for indigenous pregnant women already takes place, but the hospital wants to expand the range of actions. For example, training professionals to serve the different ethnic groups, respecting intercultural contexts, adapting the physical structure and continuing education activities in the villages.

“We have several villages in the region, each with specific characteristics and different needs. There is a great lack of assistance, a lot of fragility in prenatal care. The pregnant woman is not always able to have all the consultations and tests recommended by the Ministry of Health.”

Amana, Tainaçã’s mother, confirms that there are many difficulties in providing care. “Sesai’s teams [Secretaria Especial de Saúde Indígena] are few. Access to transport is also difficult, insufficient to meet the demand of 23 communities in the region”, he says.

According to her, this was the reason why her daughter did not have six prenatal consultations, the minimum recommended by the Ministry of Health.

These difficulties are repeated in several indigenous territories in the country. Data from the 2019 National Survey of Health and Nutrition of Indigenous Peoples show that most of these pregnant women (60%) had five or fewer prenatal consultations. And only a third (33%) started this care in the first trimester of pregnancy.

According to a study published in Cadernos de Saúde Pública, based on the survey, there is a great disparity in the supply of prenatal care in the first quarter between the regions of the country and there is a gap when compared to the service offered to non-indigenous women.

For example, only 21% of indigenous women in the North had access to prenatal care in the first quarter, while among non-indigenous women the rate was 35%. In the Midwest, the rates were 44% against 58%, in the South and Southeast, 33% against 57%, on average.

There is also a low availability of tests for indigenous pregnant women during prenatal care. Some examples: blood glucose (54%), urine (53%), blood count (57%), cytology (13%), syphilis (58%) and HIV (44%), hepatitis B (54%), rubella ( 21%), toxoplasmosis (33%).

Another study published this month by Fiocruz (Fundação Oswaldo Cruz), with 469 indigenous women from Mato Grosso do Sul also showed that the low percentages of prenatal care are related to inequalities in access and adequate care for the needs of indigenous pregnant women.

Most of those surveyed were Guarani Kaiowá, lived in a village and had prenatal care at a basic indigenous health unit. About half had seven or more prenatal consultations (51.5%), 37.2% between four and six consultations and 11.3% had none or one to three consultations.

Regarding delivery, 355 (75.7%) underwent vaginal delivery and 114 (24.3%) cesarean section. According to researcher Renata Picoli, coordinator of the study, a cesarean section can pose even greater immediate and long-term risks to indigenous women because they live in distant places and offer limited obstetric care.

“These indicators signal a worrying situation, which needs to be discussed so that we can minimize possible negative outcomes for maternal and child health”, he says.

The maternal mortality ratio among indigenous people increased during the Covid pandemic. According to an analysis by Vital Strategies, between 2018 and 2012, it went from 99 to 149 deaths per 100,000 live births. Among white women, it went from 49.9 to 118.6 deaths. Among brown people, it went from 55.5 to 96.5, and among black women, from 104 to 190.8 deaths per 100,000, the highest among all groups.