Human Rights, decentralization and maternal health in Rio de Janeiro: An NGO perspective

Abstract

Brazil has one of the largest rates of maternal deaths in the world and it accounts for over a quarter of Latin America's maternal deaths. Notably, in spite of the influence of the feminist movements on reproductive public policy making, minority women are still disproportionately affected. The highest maternal mortality rates are among black, indigenous, and single women living in the poorest regions of Brazil. The objective of this paper is to examine the truth of this problem through the local perspective of a non-governmental organization in Deodoro. Although the data presented here is neither conclusive nor representative they show that the socioeconomic and demographic profiles of maternal deaths in the city of Rio de Janeiro reflect a vulnerable social situation. Yet, the government has remained unresponsive to the real needs of the women of Deodoro and their families , thus affirming the World Bank view that Brazil is disproportionately directing government spending for health to the affluent while the poor lack access to basic health services and receive low-quality care. There are also health sector fragmentation, loss of policy leadership, confusion of responsibilities and deterioration of services due to the adoption of top-down policies which in turn create further complications and discrepancies in health policies. This does not mean that in Deodoro the women have full control of all aspects of their reproductive life. It means that the official discourse of the modern Brazilian State was at times embraced, combined or rejected by informal local groups and individuals.

Keywords: Brazil, decentralization, health reform, maternal health, NGO, public policy