Black and Indigenous women die more often from cervical cancer, survey shows

Researchers from São Paulo, Minas Gerais, and Bahia map data and show the impact of racism on the healthcare system

The image shows two Indigenous women in the foreground, taking part in an outdoor event in bright daylight. Both wear green feather headdresses and have traditional body paint on their faces. The woman on the right holds a maraca (a percussion instrument) raised firmly in a gesture of strength and expression. Her face is painted in red and black, and she is adorned with necklaces, colorful beaded bracelets, earrings, and feather ornaments around her neck and chest.

Over the past 20 years, mortality from cervical cancer, the third leading cause of death among women, has declined overall. Among Black Brazilian women, however, the decrease was much smaller, with figures practically remaining stable during this period. For Indigenous women, the trend moved in the opposite direction, rising from 4 deaths per 100,000 women in 2002 to almost 13 per 100,000 in 2021.

The data come from a study conducted by researchers from the states of São Paulo, Minas Gerais, and Bahia, and is the first to examine the relationship between race/color and mortality from cervical cancer—a disease for which early screening can prevent late diagnoses and undesired outcomes. The study analyzed 133,000 deaths that occurred between 2002 and 2021, using data from the Brazilian Institute of Geography and Statistics (IBGE) and the Mortality Information System.

In 2002, the difference in mortality between white and Black women was 0.08 per 100,000. By 2021, that gap had widened to 1 in 100,000.

According to the authors, racial disparities in the implementation of strategies and targets must be taken into account when developing women’s health policies.

“The racial disparities in cervical cancer mortality can be explained by the unequal distribution of social resources. Although this situation stems from poverty, it is intensified by racial inequality. Since Pap smears, timely diagnosis, and treatment are the main interventions for controlling the disease, limited access to these services helps explain the differing mortality rates,” say the authors affiliated with the Pólis Institute, the State University of Feira de Santana, the USP School of Medicine, and the Federal University of the Jequitinhonha and Mucuri Valleys.

High quality data

Reliable, high-quality data are essential for uncovering the effects of racial inequality, but one of the main challenges lies in the incompleteness of the race/color field in major health information systems. According to the Ministry of Health’s special bulletin “Health of the Black Population,” the percentage of missing data has been steadily declining since 2010.

The bulletin notes that during the Covid-19 pandemic, beginning in August 2020, this situation began to improve after the race/color field category in the Influenza Epidemiological Surveillance Information System (SIVEP-GRIPE) was changed from “essential” to “mandatory.” It is also worth recalling that since 2017, completing the race/color field has been a requirement across all information systems used by Brazil’s Unified Health System (SUS).

“There are many barriers to filling in this field, ranging from a lack of awareness about the importance of the data to manifestations of interpersonal and institutional racism, and even discomfort among health professionals when asking ‘how do you self-identify?’ Raising awareness among healthcare teams responsible for diagnosis and data entry is as vital for improving data quality as it is for formulating and funding effective intersectoral policies within a comprehensive healthcare network,” the authors write in the document’s introduction.

Structural racism

Although Black people In Brazil make up more than half of the population, public health research only began to address their specific needs in the 2000s. The Special Secretariat for Policies to Promote Racial Equality (SEPPIR) was created in 2003, followed soon after by the National Policy on Comprehensive Healthcare for the Black Population (PNSIPN).

“After the abolition of slavery, social and economic policies deliberately excluded Black people from the production of and access to goods and services. This dynamic has since been reflected in numerous forms of racial injustice, with unequal and harmful effects on patterns of illness. The false notion of a ‘racial democracy’ concealed this exclusion. Incorporating race and color into health information systems will help to uncover a reality that had long remained invisible,” says Olinda Luiz, professor of the Department of Preventive Medicine at the USP School of Medicine, and one of the authors of the study that identified disparities in cervical cancer mortality rates.

Black women have worse indicators for prenatal care access and higher mortality rates during pregnancy, childbirth, and the postpartum period, according to a study by the Institute for Health Policy Studies.

This same disparity likely extends to many other health outcomes. “Without a doubt, almost all health indicators show stark racial differences, with worse numbers for Black people and worse still for Indigenous people,” warns Luiz. One example of racial inequality she highlights is maternal mortality, “which could be prevented in more than 90% of cases.” Black women have worse indicators for prenatal care access and higher mortality rates during pregnancy, childbirth, and the postpartum period, according to a study by the Institute for Health Policy Studies conducted using data from 2014 to 2020.

Although public health policies are central to addressing these issues, scholars agree that the problem cannot be separated from its broader social context. “Interventions must go beyond healthcare. Reparative and inclusion policies are fundamental. Measures such as racial quotas in education and economic initiatives, among others, tend to be more effective than isolated actions limited to the health sector,” concludes Olinda Luiz.

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