O cuidado em saúde de mulheres negras em uma maternidade de referência em Manaus: uma análise interseccional

Abstract

Introduction: This thesis investigated the experiences of Black women in obstetric care at a public referral maternity hospital in Manaus, from an intersectional perspective. It starts from the recognition that racial health inequalities in Brazil constitute structural dimensions that hierarchize bodies and territories, affecting Black women in the Amazon in a particular way. Justification: Understanding how these inequalities permeate obstetric care in the Amazon region is essential to broaden the debate on institutional racism in health and to support public policies that consider racial, gender, class, and territorial specificities. Objectives: The general objective was to understand how Black women experience health care in a referral maternity hospital in the Amazon, considering the intersections of race, gender, class, and territory. Three specific objectives were defined: to examine experiences related to the care provided, with a focus on strategies to confront institutional racism; to analyze the interactions between Black women, health professionals, and companions during childbirth and hospitalization; and to describe the birth trajectories, observing the power dynamics related to different social markers. Methodology: This is a qualitative, exploratory research guided by the narrative approach. Fieldwork took place in a referral maternity hospital in Manaus in the second semester of 2024 and included 13 narrative interviews, participant observation, and field diary records. The material was submitted to thematic content analysis (Minayo), supported by the theoretical frameworks of intersectionality, Black feminism, and decolonial thought. Results: The findings indicate that obstetric care is configured as a field of disputes, marked by the continuity of practices permeated by racial, gender, and class inequalities, while at the same time collective and individual resistances emerge, expressed in strategies of solidarity, rights claiming, and the development of self-defined practices of care. It is also evident that structural and territorial conditions of the Amazon intensify vulnerabilities but also enhance forms of resistance. Conclusions: Analyzing obstetric care from the perspective of Amazonian Black women broadens the debate on institutional racism in health and reinforces the need for intersectional public policies, in addition to contributing to Public Health by recognizing Black women as epistemic subjects and protagonists of their own care trajectories.