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.

Examples of Violation of the Right to Health

* Eleonora Menicucci de Oliveira and ** Lúcia Maria Xavier

 Brazil, 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.

 Since 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.

 The 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.

 There 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.

 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. Maternal death rates have been stable since 1990 at levels incompatible with the level of economic development reached by the country.

 Racism 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.

 There 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.

SUS still has difficulties with regard to:

a)Access:

 - 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.

b) Financing:

-Insufficient budgetary provision for health, an outgrowth of the current economic model in force.

-A perverse tax system that is inadequate to guarantee the constitutionally-stipulated health provisions.

2-Examples of violations of the right to health

2.1-Maternal Death in the municipality of Barreiros, Pernambuco

  The 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.

  Analyzing 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 of Barreiros-PE.

  Of 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.

  All 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.

  For 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.

  We 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.

  This 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 national tragedy.

  2.2 Contamination by various agrochemicals in the Municipality of Paulínea/São Paulo by Shell Corporation

  In 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 Corporation.

  The 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.

  It 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.

  In 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 mineral oils.

  The 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.

  In 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 behavior.

  In 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 residents’ association.

In 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

Atibaia 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.

  During its period of operation, at the Shell industrial plant, 844 workers were exposed to pollutants, according to the Unified Chemical Workers’ Union.

  It 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.

  The 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:

1)    Access to the records, exams, and health studies performed on all the workers;

2)    the guarantee of specific health examinations, of good reliable quality, furnishing an account of the present health condition of the workers;

3)    a list of all workers, former employees or not, that worked at the Paulínea plant;

4)    Information on substances, products, and wastes handled at the Shell Paulínea Industrial Center – CISP.

* Eleonora Menicucci de Oliveira is National Reporter for the Right to Health.

** Lúcia 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