Building reproductive justice with indigenous women in the Northeast of Brazil

在一个高度多元化的社会中，我们如何建立一个尊重和保护种族、文化和宗教差异的医疗体系？在一个性与生殖权利和土著权利受到越来越大的政治压力的社会中，我们如何建立一个医疗保健系统，保证土著社区妇女在性与生殖健康（SRH）问题上的决策权？传统治疗实践在构建生殖正义中的作用是什么？该项目与来自巴西东北部Pankararu和Xukuru社区的研究人员和活动人士合作，解决了这些问题。虽然土著人民有自己的医疗保健系统，并且分别就土著和妇女的医疗保健制定了单独的国家政策，但巴西土著主义仍然几乎看不到土著妇女，并且在性健康和生殖健康领域长期面临结构性不平等。研究表明，巴西北部土著妇女的产妇死亡率是非土著人口的2-4倍。重要的是，Xukuru和Pankararu妇女经常在土著领土外分娩，剖腹产率远远高于世界卫生组织建议的剖腹产率。这表明在获得保健服务方面存在严重问题，这些服务也未能预防性病/艾滋病毒/艾滋病和子宫颈癌，但数据仍然很少。近年来，特梅尔和博尔索纳罗政府对土著人民的暴力行为不断增加，以及covid - 19的爆发，加剧了这些问题。联邦最高法院承认土著社区面临的生存威胁，并于2020年首次确认土著人民的健康权以及在涉及其权利的任何问题上“文化间对话的必要性”。在此背景下，该项目旨在根据土著妇女的文化习俗，加强土著妇女获得性健康和生殖健康护理的机会，从而巩固生殖正义。它通过实证研究土著关于性健康和生殖健康的概念以及这些概念在巴西法律、政策和医疗实践中的适用方式来实现这一目标。它通过分析国家和区域法律和政策，并与土著领导人、活动人士和决策者进行访谈，审查违反性别优先地位的行为及其影响。该项目特别关注保健专业人员和传统治疗师在构建生殖正义方面的作用，以及他们之间的关系如何影响对文化敏感的性健康和生殖健康服务的提供。它通过组织访谈和参与观察来实现这一目标，其中包括医生和巫师。所有调查结果将通过两次前馈讲习班、两次培训会议、编写最后报告以及与当地艺术家合作编写的教育材料，与土著社区成员、决策者和保健专业人员分享。该项目还将出版3本高质量的学术出版物、一本期刊特刊和几篇会议论文。该项目是与土著社区成员共同制作的，将首先使寻求性健康和生殖健康护理的人受益。虽然Xukuru和Pankararu社区大约有2万成员，但在巴西，有来自305个民族的近90万土著居民。第二，该项目将使巴西东北部及其他地区参与医疗保健领域的决策者和土著活动人士受益。第三，它将使在特殊土著保健系统内外提供服务的保健专业人员受益。负责保护土著权利的地区检察官办公室以及巴西东北部土著人民和组织代表的支持将促进该项目的影响。

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.