Maternal deaths are
responsible for 6% of the deaths of women between the ages of
10 and 49, and are among the 10 primary causes of death in the
Brazilian population. It is estimated that 3,000 deaths occur
every year of women in the pregnancy-childbirth cycle.
of Violation of the Right to Health
Menicucci de Oliveira and ** Lúcia Maria Xavier
on adhering to the International Pact on Economic, Social, and
Cultural Rights, took an important step for the implementation
of Social, Economic, and Cultural Human Rights.
1988, Brazil has established Health as a right of everyone,
with the State obligated to guarantee its full realization.
And, to this end, it set up the Single Health System (SUS),
the premises of which are universalization of access,
integrality of attention, impartiality, decentralization of
management, a hierarchy of services, and social control.
transformation of the economy and of labor relations, the
persistence of pockets of misery and hunger, the lack of
governmental policies and basic infrastructure, the
deterioration of the environment, the growth of violence in
the countryside and in the city, the permanent threats of
epidemic outbreaks and chronic endemic illnesses directly
affect living conditions, causing an imbalance of health.
are distortions and lacks in the levels of assistance, in
spite of the expansion of municipal health services in some
regions of the country. And there is still a greater
concentration of public spending in the southern and
southeastern regions for the maintenance of hospital units.
deaths are responsible for 6% of the deaths of women between
the ages of 10 and 49, and are among the 10 primary causes of
death in the Brazilian population. It is estimated that 3,000
deaths occur every year of women in the pregnancy-childbirth
cycle. Maternal death rates have been stable since 1990 at
levels incompatible with the level of economic development
reached by the country.
has been an important factor in determining the ways of birth,
life, and death of the Brazilian population. This affects the
access of Black people to social benefits such as basic
sanitation, a balanced diet, housing, employment, health
services, and also social acceptance. This translates for
example, into a greater infant and maternal mortality and
lower life expectancy. Racism also influences the progress of
diseases, the large part of which are preventable, but have
not received due attention by the government.
is a total lack of preventative public policies regarding
deterioration of the environment and for remediation of areas
and populations that have already been contaminated.
still has difficulties with regard to:
Of the 55,226 health establishments, 38% are situated in the
southeastern region, with 14% of these having hospital
admissions, 73% not having hospital admissions, and 13%
devoted to diagnosis and therapy. Support services for
diagnosis and therapy are concentrated in the southern (20%)
and southeastern (55%) regions. Of 7,241 establishments, only
3% are in the northern region.
Of the 486 thousand hospital beds linked to SUS, 2.8
per thousand inhabitants or 65% are in private hospitals, 26%
are in public hospitals, and 9% are in university hospitals.
The supply of beds per thousand inhabitants is greater in the
center-south, with higher indices in the Central-West Region
(3.3 beds). The lowest index is in the Northern Region (1.9),
with the least supply being in Amazonas (1.6). The private
hospitals are concentrated in the Southern and Southeastern
Regions with, respectively, 80% and 74% of the total beds of
these areas. SUS’s UTI beds come to 11 thousand; half of
these in private hospitals, 27% in university hospitals, and
23% in public hospitals.
Lack of public coverage for basic health services,
particularly prenatal and childbirth services.
Failure to establish the Women’s Health Integral
Assistance Program – PAISM
Urgent care and emergency services end up being the
entry door of the health system.
Lack of free access to medicines through SUS.
Lack of policy regarding ethnically/racially determined
diseases, especially for descendants of Africans.
budgetary provision for health, an outgrowth of the current
economic model in force.
perverse tax system that is inadequate to guarantee the
constitutionally-stipulated health provisions.
of violations of the right to health
Death in the municipality of Barreiros, Pernambuco
sources used for this study were information from household
interviews with content that included socio-economic
conditions, reproductive and health history, and possible
facts that occasioned death, a copy of the death certificate,
some pages from copies of the medical records of the women
with a history of maternal death.
the five maternal deaths, it was found that all were seen
initially at the João Alfredo maternity hospital (private
institution contracted with SUS), located in the municipality
these five women, one died at the João Alfredo maternity
hospital before being transferred; the others reached the
Santa Rosa Health Center, located in Palmares-PE, where they
died. It is important to point out that the transfers were
made in an irregular manner; the women in a critical state
were transferred by ambulance without medical attendance. We
stress that it is the responsibility (including legal) of this
category of professional to accompany persons who are in
critical condition when being transported by ambulance. In
this study it was found that the five deaths occurred due to
direct obstetric causes involving eclampsia and hemorrhaging
(uterine rupture of the body and segment and of the cervix
uteri), all of them presumably preventable.
five women had not had pre-natal attention and we found that
in two consultations there were already clinical signs of
elevated arterial pressure in one of them (AEM). We say this
given that we have identified a number below a minimum of 6
consultations, as set by Prenatal Assistance Technical
Standards: two of the pregnant women only had 2 consultations,
two had only 4, and one had no consultations.
three of the women, health conditions upon admission at the João
Alfredo maternity hospital were good or normal, indicating
that, at the hospital level, these deaths probably could have
been prevented if they had received assistance as provided for
by the Brazilian Federal Constitution, Assistance Process
Standards of the Ministry of Health, and professional
qualification. Two of them arrived already in grave condition,
but did not receive adequate assistance to stabilize the
critical state in which they found themselves.
found that attention was absolutely inadequate at both the João
Alfredo maternal hospital and the Santa Rosa Health Center.
Noting, for example, that the documents studied revealed that,
faced with a state of eclampsia, the treatment plan (Sulfate
of Magnesium) was not performed and maintenance was
incompatible with the woman’s identified needs, leading us
to state that the professionals at these two institutions
urgently need professional evaluation and new assignments. The
João Alfredo maternity hospital, principally, needs immediate
intervention, given that the proof of professional
irresponsibility is so glaring.
situation can be extended throughout the country, where we
still have one of the highest maternal mortality rates in the
world: 158 per 1000 live births—an absolutely preventable
Contamination by various agrochemicals in the Municipality of
Paulínea/São Paulo by Shell Corporation
the 70s, Shell Corporation set up an industrial unit
manufacturing agricultural chemicals in the municipality of
Paulínea, State of São Paulo, in an area next to a
residential neighborhood called “Recanto dos Pássaros”:
1974 – Site acquisition by Shell.
1977 – Beginning of operations.
1984 – Beginning the production of herbicides.
1989 – Beginning the production of insecticides.
In 1996 the factory was purchased by Cyanamid.
In July of 2000 the factory was acquired by BASF
various agrichemicals that came to be manufactured there
included Aldrin, Endrin, and DDT, and the production of
insecticides. During its period of operation, Shell utilized
two incinerators and a burn pit that, for more than a decade,
burned various solid wastes (general sweeping, remains of
packaging, maintenance material, individual operator safety
equipment, etc.), in addition to the burning of solid and
liquid chemical waste. These products were banned by the
United Nations Health Organization, due to their association
with cancer rates and other diseases.
should be pointed out that the incinerators were deactivated
after 16 years of use due to their not meting the technical
emission standards required by the Environmental Sanitation
Company of the State of São Paulo – CETESB. During this
period, the company contaminated the water in the Atibaia
River, an important water source of the region.
February of 2001 the Dutch consulting firm Haskoning advised
Shell to perform a stricter monitoring, which detected the
presence of heavy metals (nickel, copper, zinc, lead,
aluminum, and arsenic), organoclorate pollutants (drins), and
case definitely warranted space in the press. In February of
2001 nearly 100 residents of the region kept a vigil for
several days in front of the factory.
September of 2001, Greenpeace sent a report on the case to the
directors of FTSE 4 Good, an index linked to the London stock
market for investment in socially responsible investment,
which lists companies in accordance with their ethical
December of 2001, the Justice Department of the State of São
Paulo determined that Shell should relocate the residents in
the 66 houses of Recantos dos Pássaros. Shell should also
guarantee any necessary medical treatment. The company is the
target of a public civil suit initiated by the Paulínea
mayor’s office, the Public Ministry, and the neighborhood
February of 2003, the entire area of the neighborhood next to
the company’s factory, suffered a large flood, due to the
inundation of the
River. This increased the risk of exposure and contamination
of the population. The entire area was interdicted by Paulínea
Civil Defense, with removal of all residents who were still
there, with the exception of three families who refused to
abandon their homes.
its period of operation, at the Shell industrial plant, 844
workers were exposed to pollutants, according to the Unified
Chemical Workers’ Union.
is important to point out that the agrotoxic produced and
handled by these workers was developed and patented by Shell
itself, with it creation and formulation kept secret by the
company. Today, the old Shell factory belongs to BASF, which
bought it from Cyanamid in the year 2000.
workers union had tried to establish direct contact with Shell
and, after many unfruitful attempts, only achieved anything
concrete when a meeting was set up on May 5, 2001, when the
workers presented a
list of demands containing the following points:
Access to the records, exams, and health studies
performed on all the workers;
the guarantee of specific health examinations, of good
reliable quality, furnishing an account of the present health
condition of the workers;
a list of all workers, former employees or not, that
worked at the Paulínea plant;
Information on substances, products, and wastes handled
at the Shell Paulínea Industrial Center – CISP.
Menicucci de Oliveira is National Reporter for the Right to
Maria Xavier is Coordinator of Criola (A Black Women’s
Organization), and National Advisor for the Right to Health..
Gazeta on line; 12/12/2002