Interview: Conceição Lemes
A protest movement against the Provisional Measure 577 (MP 577) creating the National System of Registration, Tracking and Follow-up of Pregnant and Puerperal Women for the Prevention of Maternal Mortality Amongst is expanding amongst feminists and other groups advocating for comprehensive women’s health and women’s sexual and reproductive rights. The decree was signed by Pres. Dilma Roussef and the Ministers Alexandre Padilha (Health), Guido Mantega (Treasury) and Miriam Belchior (Planning) and issued on December, 26th, 2011, during Christmas leave. “Nothing justifies a MP 577 that becomes law even before its approval by Congress, except the desire to pass it without debating its content with the society”, criticizes Sonia Correa. “Imagine if the government issued a MP make HIV testing and the declaration of the HIV status compulsory? Or, maybe without going that far, if it made make compulsory syphilis testing. Right away huge numbers of people would scream quite loud, wouldn’t they? But since this measure is about women and motherhood, violation of privacy is easily allowed. ”
Founder of SOS Corpo, a feminist organization based in Recife (Pernambuco state), Sonia has been involved in international and national advocacy and research activities since the late 1970’s. She has been a member of the National Commission of Population and Development between 1995 and 2004 and now co-coordinates Sexuality Policy Watch (SPW), an international project based at ABIA (Brazilian Interdisciplinary AIDS Association), in Rio de Janeiro.
Viomundo – As a “historical” feminist activist, what is your evaluation about the MP 577?
Sonia Correa – It is unnecessary and absurd in various aspects.
Viomundo – For example?
Sonia Correa – To begin the constitutional rule for the enactment of a provisional measure (MP) is of high urgency. In other words it is made into law right away. If it is not approved right away it blocks processing of other legislative measures postponed. There is no urgent justification for the MP 577. Maternal mortality rates are indeed a major problem, but they have been stable for many years and there is no silver bullet policy that will make them decline swiftly. Reducing maternal mortality requires persistent long term investments. Since the MP was published, I have been asking myself: Why a MP? Is this aimed to send a message to society that the states want a strong norm to resolve maternal mortality? Is it the urgency to define in the 2011 budget the necessary total amount of resources as to disburse the R$ 50 per pregnant woman in 2012? Well, if the government wanted to send a strong symbolic signal, why not do it through the regular processing of a law provision, which would allow – even if in restricted way – the society to be heard. If the issue was to guarantee resources for the 2012 budget, a specific MP could have been issued in relation to the financial aspects, while the health surveillance and program monitoring could have been solved via a sanitary administrative norm issued by the Ministry of Health (MoH). Sanitary rules in Brazil are strongly enough in normative terms, as to guarantee policy implementation, but can be more easily changed, if needed. From a legislative point of view, this MP is like a a drone. It creates urgency, block the legislative process and creates a Congressional dynamics in which it is really difficult for the society to intervene. To make it more direct, it is an extremely authoritarian tool, considering the subject matter under discussion.
Given that there were other and more flexible options, I can only interpret the choice of a MP as the fastest way to curb the debate, to make it easier to install, at all costs, a vigilante policy to implement a systematic surveillance of women’s reproductive life. I want also to remind that the text includes a mention to the unborn. In Article 16 and 19 the MP 577 reads that the mother and unborn child there must have the right to prenatal, childbirth and postpartum care.
This new semantics entirely changes the consecrated public health language that woman is the main subject of health care policies, as to, surreptitiously, introduce in the text the concept of the right of the unborn. This concept is at the core of the Statute of the Unborn, currently under consideration in the House Budget Committee and its rapporteur is Congressman Jean Wyllys (PSOL-RJ). The Commission on Bioethics and Biolaw of the Bar Association of Brazil in Rio de Janeiro section (OAB-RJ), of which I am a collaborator, elaborated solid opinion on the anti-constitutional aspects of the draft bill in question.
Viomundo – Will the $ 50 for pregnant women enrolled contribute to reducing maternal mortality?
Sonia Corrêa – There is no doubt that $ 50 can, in fact, help in some needs of poorest women, such as transportation. But it is also essential to make clear that:
1) The National Public Health System (SUS) has already a sophisticated system of data collection, including specific surveillance and monitoring systems for prenatal childbirth and post-partum care known as SIS-Prenatal. In cases where this surveillance system does not work — and this happens in many places, it is due to management incompetence. There is no need for an additional system. Rather what is needed is yo make effective what is on place.
2) Since 1997, the National Health Council passed a resolution making maternal death an event of compulsory notification. Due to technical problems, this resolution would be finally adopted in 2004 when the National Pact for the Reduction of Maternal Mortality was established. This means that proposed by MP 557 duplicates what already exists. And I really do not think it will resolve the problems observed in the national surveillance and investigation of maternal deaths, which are explained by structural factors.
3) Considering our GDP, per capita income and coverage of the public health system, maternal mortality rates in Brazil are very high. Unlike other countries, as sub-Saharan Africa, India, Nepal or, closer to us, Bolivia, maternal mortality rates in Brazil are not due to problems of access to prenatal care. Our coverage is reasonably good: more than 90% of births occur in hospitals or are accompanied by trained staff. Our key problem is the poor quality of care in prenatal and obstetric care. The percentage of maternal deaths that occur in hospitals is over 60 percent. We have a grave problem of hospital based lethality.
This means that neither the $ 50 cash transfer nor the new and duplicating surveillance measures proposed by the MP with resolve the key factors explaining the high rates of maternal death, that persist despite the wide coverage of prenatal care. I’m talking about the lack of training and often lack of commitment services and health professionals, lack of equipment and other obstacles related to health management issues, no to mention discrimination of certain groups of women in health care, especially black women.
It is unfortunate that in order to get a cash transfer of 27 US$, as to take a bus or cab to reach prenatal care clinic, poor women will be subject to this form of compulsory registration, which is undoubtedly a form of vigilantism.
Viomundo – But epidemiological surveillance has always another aim. Its is not really about watchdogging someone, in the same way as the police behave….
Sônia Correa – Yes, but we can not forget that historically measures of public health surveillance, adopted on behalf of the public good, have potentially turned into state mechanisms of coercion and invasion of privacy. Our era is one in which many forms of vigilantism at work, especially after 9/11. We experience a global climate of public security that tends to infiltrating all areas of social life. A striking illustration is the plethora of criminal laws passed or proposed to regulate the Internet, including the Azeredo Law in Brazil.
In the specific case of the MP 557, this watchdogging is wrapped-up by an ideology that aims at preserve sex-gender systems as they are: the ideology of maternalism. “Theoretically” the MP aims at saving mothers and babies lives, consequently invasion of privacy is easily justified. This appeal to maternalism obscures the many distortions and the very inutility of MP 557. It is worth reminding that the text as it is now does not even mention the words confidentiality or privacy.
Viomundo – What is maternalism?
Sônia Correa – Maternalism is a shorthand to describe a wide and diverse set of views and perspective that for centuries have crystallized in the hearts and minds of people the imagery of women as mothers. It is interesting to observe that these conceptions or ideologies are both religious and secular. One religious example is the catholic Marianism , ie, the persistent identification of women with the Virgin Mary or Mother Mary, which has been always very present in Latin America since the colony and has been strongly reactivated by the Vatican since Pope John Paul II.
But I can also mention scientific and philosophical discourses of the Enlightenment, which emphasized the women’s biological and hormonal “difference” to justify why it was not appropriate for them to engage with for public affairs and should therefore devote their lives to private and reproductive tasks. More recently, after the Second World War, when in Europe and the U.S., women were sent back home, maternalism was reactivated once again by various means. A classic example is Dr. Benjamin Spock’s book, the American pediatrician, which was widely disseminated among Brazilian doctors and middle class families. As Elizabeth Badinter [one influential French intellectual and feminist] says, maternalism is an easy ideological resource to push women back to where they have always been, as the popular Brazilian saying reads: women’s is at the kitchen or the laundry tub. The struggles for sexual and reproductive rights in the second half of the twentieth century have been mostly about challenge this ideology of motherhood as the only destiny of women’s bodies.
Imagine, for a moment, if the government had issued a MP make HIV testing and the declaration of the HIV status compulsory ? Or, maybe without going that far, to make compulsory syphilis testing. Right away huge numbers would scream quite loud, wouldn’t they? But since this one is about women and motherhood violation of privacy is easily allowed. ”
Viomundo – Why?
Sônia Correa – Because the social construction of male and female bodies is strongly associated with images and construction that conceive the feminine as “out of order”, as bodies and persons that always in excess and not always to care for themselves, properly. Given that their bodies are seen as instruments to deliver babies for the state, for the labor market, for the families, women must be protected in order to behave well. The poorer the women are, tighter the rules will be.
Viomundo – But the register is mandatory for all pregnant women.
Sônia Correa – In fact, as it is written in the MP, all pregnant women are supposed to be registered. But we do know that historically but also in the practice of Brazilian society poor people are always more subject to state control, especially when there are financial dependence ties to state institutions. The MP 557 contributes to that because, in practice, it will watchdog more closely those who are less autonomous in economic terms and depend on the 27$. These are the ones who, in name of public health and maternalism, will be more closely surveilled.
Viomundo – So, what’s next?
Sônia Correa – The flow of the debate is now running free in the society, despite the attempt to curb the discussion. This is the most important aspect right now. If the critique in sustained and keeps sharp path will be open for more organic and articulated political and advocacy actions against MP 557 to take form. During January, much water still will flow under the bridge, in addition to the heavy summer rains that, unfortunately, and once again are provoking disasters and life losses. In my opinion, it would be really great if the Brazilian government could spend a bit more of their monitoring and surveillance energy with these disasters, instead of investing such an effort to control the private decisions of individuals, in particular women.