Racial inequalities and perinatal health in the southeast region of Brazil

ABSTRACT

Few studies are available about racial inequalities in perinatal health in Brazil and little is known about whether the existing inequality is due to socioeconomic factors or to racial discrimination per se. Data regarding the Ribeirão Preto birth cohort, Brazil, whose mothers were interviewed from June 1, 1978 to May 31, 1979 were used to answer these questions. The perinatal factors were obtained from the birth questionnaire and the ethnic data were obtained from 2063 participants asked about self-reported skin color at early adulthood (23-25 years of age) in 2002/2004. Mothers of mulatto and black children had higher rates of low schooling (ú4 years, 27.2 and 38.0 percent) and lower family income (ú1 minimum wage, 28.6 and 30.4 percent). Mothers aged less than 20 years old predominated among mulattos (17.0 percent) and blacks (14.0 percent). Higher rates of low birth weight and smoking during pregnancy were observed among mulatto individuals (9.6 and 28.8 percent). Preterm birth rate was higher among mulattos (9.5 percent) and blacks (9.7 percent) than whites (5.5 percent). White individuals had higher rates of cesarean delivery (34.9 percent). Skin color remained as an independent risk factor for low birth weight (P < 0.001), preterm birth (P = 0.01), small for gestational age (P = 0.01), and lack of prenatal care (P = 0.02) after adjustment for family income and maternal schooling, suggesting that the racial inequalities regarding these indicators are explained by the socioeconomic disadvantage experienced by mulattos and blacks but are also influenced by other factors, possibly by racial discrimination and/or genetics.