Resumo
In the last 20 years there was an improvement in
access to services and in almost all maternal health
indicators in Brazil. Paradoxically, there is no evidence
of improvement in maternal mortality. This paper
aims to help to understand this paradox, by analyzing
the typical models of care in childbirth in public (SUS)
and private sectors; the proposals for change based on
evidence and on women’s rights; and the conflicts of
interest and resistance to change. We review the gender
biases in research and in programming, especially the
overestimation of the benefits of technology, and the
underestimation, or the denial, of adverse effects and
discomforts of interventions. Beliefs based in sexual
culture are often accepted as ‘scientific’ explanations
of the body, sexuality and the birth physiology, and
are reflected in the imposition of unnecessary risk
and suffering, in practices that are harmful for genital
integrity, and in the denial of the right to companions
in delivery. This ‘pessimization of birth’ is instrumental
to promote, comparatively, the model of routine section.
Finally we describe how the use of gender as analytical
category can contribute to promote rights and cultural
changes, as in the case of companions in childbirth.
