Building reproductive justice with indigenous women in the Northeast of Brazil

How do we create a healthcare system that respects and protects ethnic, cultural, and religious differences in an intensely pluralist society? How do we create a healthcare system that guarantees decision-making power in matters of sexual and reproductive health (SRH) for women from Indigenous communities in a society in which both sexual and reproductive rights (SRR) and Indigenous rights are subject to increasing political pressure? What is the role of traditional healing practices in the construction of reproductive justice?

The project addresses these questions in response to and in collaboration with researchers and activists from the Pankararu and Xukuru communities in the Northeast of Brazil. While Indigenous people have their own healthcare system and there are separate national policies concerning respectively Indigenous- and women's health care, Indigenous women remain almost invisible to Brazilian indigenismo and face persistent and structural inequalities in the area of SRH. Studies have shown that maternal mortality rates among Indigenous women in Northern Brazil are 2-4 times higher than among non-Indigenous populations. Importantly, Xukuru and Pankararu women frequently give birth outside Indigenous territories and experience rates of caesarean sections far above those recommended by the WHO. This suggests serious problems with access to healthcare services, which additionally fail to prevent STD/HIV/AIDS and cervical cancer, but data remains scarce. These problems have been exacerbated in recent years by the increased violence against Indigenous people perpetuated by Temer's and Bolsonaro's governments and the outbreak of Covid19. The existential threat to Indigenous communities was recognised by the Federal Supreme Court, which in 2020 affirmed for the first time the right to health of Indigenous people and 'the indispensability of intercultural dialogue' in any question involving their rights.

Against this background, the project aims to consolidate reproductive justice by enhancing access to SRH care of Indigenous women in accordance with their cultural practices. It does so by empirically examining Indigenous conceptions of SRH and the ways in which they are accommodated in Brazilian law, policy, and medical practice. It examines violations of SRR and their effects by analysing national and regional laws and policies and conducting interviews with Indigenous leaders, activists and policy makers. The project pays particular attention to the role of healthcare professionals and traditional healers in the construction of reproductive justice and how their relationships shape the provision of culturally sensitive SRH services. It does so by organising interviews and participant observation involving doctors and shamans. All findings will be shared with members of the Indigenous communities, policy makers and healthcare professionals through 2 feed-forward Workshops, 2 training sessions, the production of a Final Report, and educational materials produced in collaboration with a local artist. The project will also produce 3 high quality academic publications, a special edition of a journal, and several conference papers.

The project is co-produced with members of Indigenous communities and will first and foremost benefit those seeking SRH care. While the Xukuru and Pankararu communities have approximately 20000 members, in Brazil there are nearly 900000 Indigenous people from 305 ethnic groups. Second, the project will benefit policy-makers and Indigenous activists involved in the field of healthcare in the Northeast of Brazil and beyond. Third, it will benefit healthcare professionals who provide services within and outside the special Indigenous healthcare system. The impact of the project will be facilitated by the support of the regional Public Prosecutor's Office tasked with the protection of Indigenous rights, and the Representation of Indigenous People and Organisations in Northeast Brazil.