Brazil: The worst country in the world for pregnant Black women

Lidiane was expecting her second child. She worked at a funeral home inherited from her father, a family business. Every day she dressed and adorned corpses for their final farewell. She had never worked harder than during the Covid-19 pandemic in Rio de Janeiro. She had been in the early months of her pregnancy when she prepared her father for his own funeral rites. Lidiane was the second of three sisters, the only one who had chosen to carry on the vocation of caring for the dead – clothing them, doing their makeup, and arranging their hands and faces with an artist’s skill. According to her sisters, Erika and Monika, she could not get sick for reasons both personal and altruistic; her income depended on the funeral home, and death’s caregivers had never been needed as much as during the pandemic. But still, Lidiane labored in fear.

She worked into her 40th week of pregnancy, when her blood pressure started spiking. She went to the maternity hospital, where she was diagnosed with anxiety and ended up having an emergency C-section, just the opposite of the humanized childbirth she had dreamed of during prenatal care. Lidiane’s sickness presented in new ways after the birth; she started gasping for air and complaining of shortness of breath. She was released without a Covid-19 test but with a prescription for psychiatric medicine to use during the postpartum period. On her medical records, the doctors said she was suffering from panic attacks and anxiety. She stayed home for two days and then, even though she felt sicker, tried to go back to work. She was preparing to care for a family whose relative had died of Covid-19 when one of her sisters forced her to return to the hospital. When they arrived there, the line of patients blurred with that of funeral cars. “It was a war scene,” her sister said.

Lidiane’s body was handed over to them in a black bag, tied shut with crime scene tape. No funeral rites, no caring for the body

It was April 2020, the month of Brazil’s first pandemic surge; we are now in the third. Back then, little was said about the risks for pregnant women. Wherever the virus went, studies had not yet demonstrated any increased risk for pregnant women. That was the case in China, Japan, South Korea, Singapore, Spain and Italy, countries with low birth rates and not many pregnant women. Until it hit Brazil. A July 2020 study found a mortality rate of 12.7% among pregnant and postpartum women in Brazil and also detected an association between death and the failure of the healthcare system: 15% of the women received no ventilator support, 28% had no access to an ICU, and 36% failed to be intubated or receive mechanical ventilation. Another study from July 2020 showed how structural racism had increased Lidiane’s chances of a tragic outcome: the risk of a pregnant or postpartum Black woman dying of Covid-19 is almost twice that of a white woman.

Lidiane may have been one of the numbers in this study. She was intubated and spent 16 days in the intensive care unit (ICU). On May 15, 2020, she died of cardiac arrest, alone, after receiving experimental treatment with hydroxychloroquine – even now advocated by President Jair Bolsonaro and Brazil’s Federal Board of Medicine, although science has proven it ineffective. Her Covid-19 test was done in the ICU, but the results were never given to the family. Lidiane’s body was handed over to them in a black bag, tied shut with crime scene tape. No funeral rites, no caring for the body. Six people held vigil for 15 minutes in a room where it was impossible to approach the casket. The sisters have a photograph of the moment: a wooden coffin with gold trim. No flowers, no messages from loved ones. On the floor, black and yellow police tape marked the distance between those in tears and the closed casket. The sisters are investigating the truth behind Lidiane’s death. They have copies of her medical records, they have heard witnesses who cared for her in the ICU, and they have tried as best they can to follow the case with the Rio de Janeiro city health department’s Committee for the Prevention of Maternal, Infant and Fetal Mortality. For the sisters, there is no doubt: Lidiane died because she was a pregnant Black woman dependent on a healthcare system entrenched in Brazil’s structural racism.

For the past two months, I have been listening to the stories of the mothers, sisters, husbands, and sisters-in-law of women who died of Covid-19 during pregnancy, birth or postpartum. This is how I came to hear Lidiane’s story and speak with her sisters, Erika and Monika, and with Amanda, a niece who accompanied her prenatal care and was the last person to talk to Lidiane before she passed away in the ICU. I’ve heard dozens of stories, in a cloudy universe of numbers where estimates are that more than 500 women have died of Covid-19 in pregnancy, childbirth, or postpartum in Brazil. The figure supposedly began dropping in September 2020, but it started rising again in 2021: 17 women in January alone. According to a report by the Pan American Health Organization (PAHO), five out of every hundred Brazilian pregnant women infected with Covid-19 have not survived, making the mortality rate nine times higher than the average for the Americas. Brazil is the global epicenter of maternal deaths from Covid-19 – if we are the world’s worst country to live in during the Covid-19 pandemic, we are the world’s worst country to be expecting a baby in. Above all, Brazil is the world’s worst country in which to try to survive the pandemic if you are a poor pregnant Black woman.

Debora Diniz is a Brazilian anthropologist and researcher at Brown University