Mixed Race Studies

Racial inequalities and perinatal health in the southeast region of Brazil

Brazilian Journal of Medical and Biological Research
Volume 40, Number 9 (September 2007)
pages 1187-1194
DOI: 10.1590/S0100-879X2006005000144
ISSN 1678-4510

L. M. Silva
Departamento de Saúde Pública
Universidade Federal do Maranhão, São Luís, MA, Brasil

R. A. Silva
Departamento de Saúde Pública
Universidade Federal do Maranhão, São Luís, MA, Brasil

A. A. M. Silva
Departamento de Saúde Pública
Universidade Federal do Maranhão, São Luís, MA, Brasil

H. Bettiol
Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto
Universidade de São Paulo, Ribeirão Preto, SP, Brasil

M. A. Barbieri
Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto
Universidade de São Paulo, Ribeirão Preto, SP, Brasil

Few studies are available about racial inequalities in perinatal health in Brazil and little is known about whether the existing inequality is due to socioeconomic factors or to racial discrimination per se. Data regarding the Ribeirão Preto birth cohort, Brazil, whose mothers were interviewed from June 1, 1978 to May 31, 1979 were used to answer these questions. The perinatal factors were obtained from the birth questionnaire and the ethnic data were obtained from 2063 participants asked about self-reported skin color at early adulthood (23-25 years of age) in 2002/2004. Mothers of mulatto and black children had higher rates of low schooling ( £ 4 years, 27.2 and 38.0%) and lower family income ( £ 1 minimum wage, 28.6 and 30.4%). Mothers aged less than 20 years old predominated among mulattos (17.0%) and blacks (14.0%). Higher rates of low birth weight and smoking during pregnancy were observed among mulatto individuals (9.6 and 28.8%). Preterm birth rate was higher among mulattos (9.5%) and blacks (9.7%) than whites (5.5%). White individuals had higher rates of cesarean delivery (34.9%). Skin color remained as an independent risk factor for low birth weight (P < 0.001), preterm birth (P = 0.01), small for gestational age (P = 0.01), and lack of prenatal care (P = 0.02) after adjustment for family income and maternal schooling, suggesting that the racial inequalities regarding these indicators are explained by the socioeconomic disadvantage experienced by mulattos and blacks but are also influenced by other factors, possibly by racial discrimination and/or genetics.

Introduction

Natives, mulattos, blacks, and whites occupy unequal places in the social networks, with differential aspects related to birth, growth, disease, and dying. Racial inequality is not limited to socioeconomic indicators related to quality of life, income and schooling but also occurs in health indicators. In the United States, which have a tradition of research on racial questions, the rates of preterm birth, low birth weight and infant mortality are higher among blacks than among whites (1,2).

Although Brazil is considered to be a country in which racial discrimination is not so significant and in which “racial democracy” prevails, significant socioeconomic inequalities related to diverse ethnic groups exist in this country (3,4). Even in cities in the south of the country, where there is better access to health services, black women have fewer opportunities to receive ideal prenatal care, with repercussions on perinatal health (5-7). In the town of Pelotas, black children have a higher prevalence of low birth weight, preterm birth and restricted intrauterine growth (8). In a study conducted in Rio de Janeiro, black mothers had lower schooling, a greater proportion of smokers and lower prenatal care attendance, cohabited less, and had a higher prevalence of pregnancy during adolescence (9). In Brazil in general, infant mortality is higher among blacks and native Indians (10).

The race/ethnic group category is not useful as a biological category, but is a social construct (11,12). In Brazil, the term race is normally used to refer to phenotype (physical appearance) rather than to ancestrality (origin), as is the case in the US. While US research is based on categories of “pure” races, in Brazil the “brown” or “mulatto” category is commonly used also to refer to cross-bred individuals (13). The determination of race in health studies is usually done by the interviewer, whereas the more recommended procedure is self-classification (11).

Few studies regarding ethnic inequalities and perinatal health have been conducted in Brazil, mainly due to low availability and/or quality of the data or to inadequate instruments for the measurement of race/ethnic origin. Questions related to the inequalities existing between individuals of mulatto and black skin colors have not been fully clarified, with these groups being usually analyzed as non-white in relation to whites. It has not been clarified whether the inequalities existing between ethnic groups regarding perinatal factors are due to socioeconomic factors or to other cultural or genetic factors. To clarify these questions, a study was conducted to analyze a cohort of individuals born in Ribeirão Preto, SP, in which skin color self-reported in adulthood in 2002/2004 was related to the social, economic, obstetrical, and perinatal characteristics of the subjects at birth in 1978/79.

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