The Marieta de Souza Pereira Normal Birth Center (CPN), which operated in Mansão do Caminho, in Salvador (BA), closed its activities this Wednesday (20). Health professionals and service users expressed concern about the decision. This is because the CPN is a reference throughout Brazil for the good assistance provided via the Unified Health System (SUS), good infrastructure and care for pregnant women.
On September 14th, the Culture Center of the Salvador City Council hosted a public hearing to discuss the closure of the Center as a matter of urgency. Tanila Amorim, an obstetric nurse who is part of Coletivo SobreParto, points out some important directions from the audience, such as the search for legal tools to guarantee the same health services to women already involved in prenatal care, postpartum women and newborns. Furthermore, a working group was suggested to create proposals for reproducing this care model.
:: Maternal death was discharged during the pandemic and worries health authorities ::
As explained by one of the members of the Movement to Dismantle the CPN, Talita Fernandes, as a private organization, the Center has the right to no longer want to maintain its activities. However, the group questions the announcement of the closure being on September 6th, with only 15 days left until the end of activities. The short period of time made it impossible to carry out an adequate transition to target the population that would be served in the space.
The objective of the Movement is to demand that the state and municipal governments and the Public Ministry of Bahia (MP-BA) face the institution’s decision, in search of reducing damage to the community and the team that will be fired. The group has also been in dialogue with the Health Secretariat of the State of Bahia (SESAB) and the Municipal Health Secretariat of Salvador (SMS) to build a new extra-hospital CPN in the capital of Bahia, capable of welcoming in quantity, but above all, in quality the gap in supply left by CPN Marieta de Souza Pereira.
“We have no hope of continuing with a CPN linked to the Mansion, but we believe that an important movement has been born to demand that the State fulfill its duty of offering this alternative”, adds Talita, who is also a doula, doctoral student in Gender and Feminism and member of Network for the Humanization of Childbirth and Reproductive Justice of Bahia.
Lawyer specializing in obstetric racism Andreza Santana informs that, together with the NGO Tamo Juntas, she filed a Public Civil Action last Monday (18). The action asks for it to be made available to pregnant women currently linked to the state and municipality and who are served by Mansão do Caminho, a service equivalent to CPN Marieta de Souza Pereira.
:: Golden August: campaign debates the rights of breastfeeding and working mothers ::
The main arguments for the closure of CPN activities presented so far are the low demand for service and the delay in the value of the funds transferred.
According to the institution, the demand for the obstetric unit was not sufficient to reach the goals of the work plan contracted with the State Government, which was 840 births annually, and cover the Center’s costs. In 2022, only 48.57% of the births expected by the government were carried out. Furthermore, in the last three years alone, the CPN generated a deficit of R$10 million for the philanthropic institution’s accounts, and is expected to have a deficit of more than R$4 million in 2023.
For Tanila, the drop in the birth rate does not justify closing the Center. The nurse attributes this situation to poor management at Mansão do Caminho, given the lack of incentive to publicize the space. “The issue of normal birth in Brazil alone responds to the low rates. We occupy the shameful second place in the ranking of cesarean sections in the world”, she explains.
:: Jurisprudence and obstetric violence: the difficult fight for women’s rights ::
In 2015, the Ministry of Health issued Ordinance No. 11, which establishes the transfer to Normal Birth Centers and the goals they must meet to be subsidized by the federal government. Talita explains that, as CPN Marieta de Souza Pereira did not reach this metric, and belongs to a private entity, the Ministry of Health suspended this transfer and SESAB was responsible for the same amount.
“From the beginning, this transfer was R$100,000 and remained that way without any update, due to the spending cap that froze the SUS table. It is a classic case of strangulation of the SUS to the detriment of the population’s health”, he assesses. The activist also highlights that politics is even more scrapped when its audience is women, black, poor and peripheral, the profile of the majority of CPN users.
Talita also denounces that, in all these years of existence, neither SESAB nor SMS made an effort to put the CPN on the population’s radar. Furthermore, the equipment is not recommended for pregnant women by the city’s primary care team, which is responsible for pregnant women’s prenatal care. Both due to ignorance of the service, and due to the “ignorant and scientifically unfounded belief” that the hospital is always the best place for birth.
For Andreza, it is necessary to think together with SESAB and SMS about strategies to disseminate the benefits of natural birth. “Women are afraid of either pain or obstetric violence. It is necessary to dissociate normal birth from suffering. The professionals themselves instill in the woman’s head that by going to these centers she is at risk. They don’t explain the strategies that allow them to function safely,” she says.
:: What do the Lula government’s initial decisions reveal regarding women’s health policies? ::
After the meeting between Mansão do Caminho and Sesab, it was decided to continue offering prenatal services to the community in the Center, but births must be absorbed by the state. As the Mansão do Caminho CPN is the only out-of-hospital facility in the city, and serves users from all over the state, the experts guarantee that there is no other space that can replace it and accommodate their demands with the same quality and respecting autonomy. of the choice of pregnant women who chose to give birth at the CPN.
“The absence of an option is a reinforcement of obstetric violence. It is the state’s duty to guarantee access to healthcare, from which we can infer that the reproduction of the extra-hospital ANC model should continue to be the proposal. There is no reason for a setback”, warns Tanila.
Talita highlights that it is not trivial that at the Center there has not been even one maternal death in 12 years of operation. “This shows the high quality of assistance provided there. We don’t have equipment in Salvador that can replace it. It is a single reference for service according to international assistance standards in this model, the State is unable to fill this void immediately”, he analyzes.
:: Brazil takes steps backwards in controlling infant mortality; 2 out of every 3 baby deaths are preventable ::
Impacts of racism
Over the 12 years of activity, the Center has carried out around 7 thousand births, remaining a reference in good care and reception practices. The loss of this space is classified by Tanila as a setback that impacts social development. The impact is even greater for black, poor and peripheral women, who according to experts are the main victims of obstetric violence.
A survey carried out by the Institute of Health Policy Studies and the Çarê Institute in 2021 shows that black women are also the main victims of maternal mortality in Brazil.
Tanila also denounces that the closure of the Center happens in parallel to “social misinformation”, due to the announcement of the displacement of births that would take place at CPN Marieta de Souza Pereira to the intra-hospital CPN at Albert Sabin hospital.
“The environments are incomparable. We need to improve the structures of the other obstetric beds in Salvador, yes, but that does not exempt us from the commitment to offering a service that is not the same as what exists in Salvador”, he adds. Furthermore, Andreza remembers that the Mansão do Caminho CPN relied on the voluntary work of doulas, unlike hospital maternity wards.
:: Structural racism leads to higher maternal mortality among black women, researcher points out ::
Talita agrees with the assessment. The doctoral student fears a rise in obstetric violence in Salvador, and also lethal outcomes in births, considering that maternity wards are already experiencing overcrowding. “All this pressure for beds encourages a rush to provide assistance on the part of professional teams, who break waters, force people to exert force, and mutilate the genitals of women in labor to get the babies out immediately,” she reports.
She explains that in-hospital CPNs still depend on the hospital’s general triage, that is, women cannot request to be seen there, they need to wait for a vacancy, regardless of the progression of labor.
“The dialogue has been maintained. Sesab and SMS have to reflect on their share of the blame. We are looking for alternatives for maintaining the Mansão do Caminho CPN, when in fact this space should have already been multiplied”, concludes Andreza.
Source: BdF Bahia
Editing: Gabriela Amorim