OBSTETRIC VIOLENCE AND INSTITUTIONAL RACISM IN THE CARE OF BLACK WOMEN: AN INTEGRATIVE REVIEW

Abstract

Obstetric violence, manifested through physical and verbal abuse, negligence, and discrimination, constitutes a violation of human rights and a global public health issue. In Brazil, evidence points to alarming racial disparities, with maternal mortality among Black women being more than twice that observed among White women in 2022. This study aimed to identify, in the literature, the prevalence and forms of obstetric violence, as well as the influence of racial factors on its occurrence. This integrative review was guided by a research question developed using the PCC strategy. The search was conducted in the SciELO, PubMed, BVS Saúde, and CAPES Periodicals databases, considering studies published within the last ten years. Primary studies analyzing obstetric violence in the Brazilian context were included, while studies that did not explicitly examine the relationship between race/skin color and obstetric violence, as well as gray literature, were excluded. Fifteen studies published between 2020 and 2025 were selected, with a predominance of qualitative approaches. The findings revealed high rates of obstetric violence, ranging from 65.3% to 93.7% in quantitative studies, except for one study that reported a prevalence of only 16.67%. The most frequent practices included the Kristeller maneuver, denial of analgesia, repeated vaginal examinations, and verbal abuse. Black women were disproportionately subjected to deprivation of care and harmful procedures, as well as greater stigma and discrimination. Socioeconomic factors were also associated with a higher prevalence of obstetric violence. Obstetric violence is an expression of social and institutional structures that reproduce historical inequalities, with institutional racism serving as a structural axis of the inequities experienced by Black women during childbirth. It is concluded that addressing obstetric violence requires changes in professional education, the organization of health services, and the promotion of women's autonomy.