In the city of Rio de Janeiro, typical users of clinics of the Brazilian Family Health Strategy are black women who suffer from chronic diseases, mothers and beneficiaries of income transfer programmes. Informally, bureaucratic staff can describe them as “difficult patients”.

Based on a two-year-ethnography of 3 urban clinics in Rio and 57 interviews with health professionals, Jaciane Milanezi explores how the categorisation “difficult” has influenced experience of accessing reproductive care within these clinics by mostly black and poor women. First, she analyses how “difficult” semantics has led to a social differentiation of health care patients, based on racial reproductive stigmas and service eligibility from an assessment of the behavior of these women. Second, she presents how discriminatory experiences emerge within these bureaucracies insofar as health professionals mobilise the notion of “difficult patients” in the decision-making processes of reproductive services. Through approaches of intersectionality, reproductive politics and governance by the State, she argues that bureaucratic mediation is a mechanism for transforming social distinctions into social inequalities.

About the speaker

Jaciane Milanezi is a Postdoctoral Researcher at the Brazilian Center of Analysis and Planning (CEBRAP) in São Paulo, Brazil, and a Visiting Fellow in the Department of Anthropology and Sociology at the Graduate Institute, Geneva. She received her PhD in Sociology from the Federal University of Rio de Janeiro (UFRJ) in 2019. Her studies analyse the relationship between race, gender and health inequalities. Her focus has been on the construction and implementation of reproductive policies for non-white women in the Brazilian racial relations context (Black Brazilians, Black Immigrants and Indigenous Immigrants), doing ethnography inside street-level bureaucracies of the Unified Health System (or SUS in the Portuguese acronym) and conducting in-depth interviews with public health employees. Her current postdoctoral research focuses on the reproductive care of Bolivians and Haitians immigrant women in the city of São Paulo. Her present book project analyses the implementation of the National Integral Health Policy for the Black Population (Política Nacional de Saúde Integral da População Negra – PNSIPN). The São Paulo Research Foundation (or FAPESP) finances her postdoctoral research and fellowship abroad.

PART OF THE GENDER SEMINAR SERIES

The Gender Centre has developed this series of research seminars in order to offer a platform for exchange for students, doctoral students in particular, and researchers whose work includes a gender perspective. During this monthly series, researchers have the opportunity to discuss their work, meet peers from different disciplines at the Graduate Institute, as well as interact with other students, guest speakers and faculty members.

See the programme of this semester's Gender Seminar Series here.
 

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