Falta de acesso aos serviços de saúde por mulheres no contexto da pandemia de COVID-19: Interseccionando cor da pele, renda e escolaridade

Abstract

There is an abundant literature showing the need to strengthen an accessible, equitable, comprehensive and problem-solving health service system. In Brazil, however, there are barriers to access to health services, especially for the black population, with lower income and less education. Objectives: The general objective of this dissertation was to analyze the lack of access to health services in the context of the COVID-19 pandemic by women, intersecting skin color, income, and education. Method: A population-based cross-sectional study was conducted with 1,107 women aged eighteen years or older living in the city of Vitória, Espírito Santo, Brazil. The interviews were conducted by trained interviewers, based on a questionnaire with multiple-choice questions using the Redcap application. The study has as a dependent variable the lack of access to medical consultation and as independent variables the skin color, income, referred to economic class, education, age, possession of health insurance and Jeopardy index understood in its literal translation as danger, as the analyses were based on multiple risk, that is, several factors of a person's identity that lead to oppression, such as skin color, income level, and education level, these can have a cumulative effect on the discrimination a person experiences. The prevalences and prevalence ratios of lack of access were calculated according to independent variables. Data analysis was performed using the Stata 13 software. Results: Out of a total of 1,107 women, 64.4% of them realized that they needed to be seen by a general practitioner. Of these, 91.9% sought care and 6.6% of them had no access to health services. The highest prevalence of lack of access occurred among adult women (9.8%; 6.7 – 14.3), non-white women (8.1%; 5.8 – 11.3), those with the lowest income level (10.6%; 6.7 – 16.2); Women without health insurance had 6 times more lack of access to medical consultations (6.6; 2.6 – 17.1). The lowest income quartile (lowest income) increased the risk of having lack of access to health services by 8 times, compared to the highest quartile (highest income). Women with primary education were 2.4 times more likely to have a lack of access compared to women with tertiary education or more. The analysis according to the Jeopardy index showed that the risk of lack of access to health services is increased when the sum of intersecting positions of oppressive social identities increases. Conclusions: It can be seen that the lack of access to health services is due to numerous factors: cultural, structural, economic and political. The adequacy of these factors to the population that most often seeks care without being able to achieve it is of paramount importance to achieve equitable health, as well as the representativeness of minority groups, in the body of professionals in health services, who must be trained, prepared, with fair salaries and with environments favorable to the work they develop to better serve this population, with a view to promoting greater accessibility to health from a holistic view.