Abstract

Pregnant women have the right to a companion of their choice during hospitalization, pre-delivery, delivery and postpartum, a right assured nationwide by Law no. 11,108, implemented in 2005. However, health protocols have restricted these rights on the grounds of mitigating the COVID-19 pandemic. Hence, this study sought to understand the approaches, actors involved, and arguments presented about noncompliance with the Companion Law during the COVID-19 pandemic by analyzing G1 Portal news articles published from March 2020 to April 2022, using the map feature. Results show that failure to comply with the aforementioned law occurred most often in the first half of 2020, justified by biosafety issues, lack of budget for purchasing personal protective equipment, and the atypical moment. In several places legal intervention was necessary for compliance, becoming a journalistic agenda, with the most emblematic case happening in Tocantins, where the veto lasted until April 2022. Analysis showed a discrepancy regarding law compliance in several municipalities and states, despite the Ministry of Health and several legal bodies having issued opinions and protocols recommending the presence of a companion.

Keywords:
COVID-19; Pandemic; Birth companion; Rights of Pregnant Women; Childbirth

Introduction

In Brazil, Law No. 11,108, of April 7, 2005, known as the Companion Law, guarantees pregnant women the presence of a companion of their choice during pre-delivery, delivery and postpartum. However, in mid-2020, with the arrival of the covid-19 pandemic, this right was restricted in several Brazilian hospitals and maternities.

This violation, in a context as vulnerable as childbirth, favored a scenario of fear, in which parturients found themselves helpless to live this moment. Diniz et al. (2014DINIZ, C. S. G. et al. Implementação da presença de acompanhantes durante a internação para o parto: dados da pesquisa nacional Nascer no Brasil. Cadernos de Saúde Pública, São Paulo, v. 30, p. S140-S153, 2014. Suplemento 1. DOI: 10.1590/0102-311X00127013
https://doi.org/10.1590/0102-311X0012701... , p. 141) highlight “there are few human experiences comparable with childbirth and birth, in terms of physical, psychological and social intensity, or that are at the same time so challenging and transformative”.

The companion plays a role emotionally and psychologically important in childbirth, and is also a barrier to the possibility of violence. The national survey ‘Being Born in Brazil’ revealed the presence of a companion offers safety to the parturient and leaves her less vulnerable to violence in labor, both in public and private services (Diniz et al., 2014DINIZ, C. S. G. et al. Implementação da presença de acompanhantes durante a internação para o parto: dados da pesquisa nacional Nascer no Brasil. Cadernos de Saúde Pública, São Paulo, v. 30, p. S140-S153, 2014. Suplemento 1. DOI: 10.1590/0102-311X00127013
https://doi.org/10.1590/0102-311X0012701... ).

Despite this, with the covid-19 pandemic this right was curtailed in several states. Health protocols removed the power of agency and autonomy of women in childbirth, impacting the right to companionship under the argument of prevention and care due to the virus circulation. This study presents a mapping of journalistic news from the website G1 on non-compliance with Law 11,108/2005 during the covid-19 pandemic in Brazil, to understand the approaches, the devices triggered, and the arguments.

Methods

This is a qualitative research, anchored in the conceptual assumptions of discursive practices and production of meanings (Spink, 2004SPINK, M. J. P. (Org.). Práticas discursivas e produção de sentidos no cotidiano: aproximações teóricas e metodológicas. 3. ed. São Paulo: Cortez, 2004.), which conceives language as the place of construction of meanings in everyday life.

The study is also based on the conception that understands journalistic discourse as a possible narrative of social events. That is, the news is understood as a result of a selection and transformation of information and occurrences, in the perspective that the journalist is not neutral, but an active participant in this process (Traquina, 2005TRAQUINA, N. Porque as notícias são como são. Florianópolis: Insular, 2005. (Coleção Teoria do Jornalismo, v. 1).).

Twenty news stories from the portal G1, which gathers journalistic content from branches and affiliates of the capital and interior of the Brazilian states, were analyzed. News texts and reports were selected for analysis through a search carried out from March 2020 to May 2022, based on the keywords “childbirth”, “companion” and “pandemic”. In the case of publications accompanied by television news videos, only textual writing was considered. For data organization, a chart was produced with the following information: date, place, title, and identification of the central theme of the news. For each text, we sought to respond to the study goal, presenting how the problem was addressed, the editor’s argumentation (positions and justifications), which actors were involved in the case and, when possible, what was the outcome of the case addressed (Chart 1).

Results and discussion

For better understanding, the information of the analyzed news can be seen in Chart 1.

Journalistic approach

In Traquina’s conception (2005TRAQUINA, N. Porque as notícias são como são. Florianópolis: Insular, 2005. (Coleção Teoria do Jornalismo, v. 1).) a newsable fact fits into criteria of news values, such as selection, considering the notoriety, proximity, relevance, novelty, time, notability, unexpected conflict, controversy, infraction, availability, balance, visuality and competition of the theme; construction, which takes into account the possibility of simplification, expansion, personalization, dramatization and consonance of the reported fact; and the editorial line of the media outlet, which defines how news - which are intended to be neutral, although often do not reach neutrality - will be addressed. Thus, the material selected on the website G1 considered the elements that constitute its news-values to understand the approach and direction.

Regarding the multiple approaches found in the analysis, the following stand out in the editorial principles of the Globo group:²2Available at:<https://g1.globo.com/principios-editoriais-do-grupo-globo.html#principios-editoriais>. Accessed on: Dec. 13, 2022

However, as can be seen in Table I, news with sometimes similar contents were approached by the same media under different biases and perspectives, not always neutral.

In news 1, 2 and 3 (Table 1), published between March and April 2020, the fact - curtailment of the right to companion - is addressed as a prevention and biosafety measure. Its titles bring the expressions “suspension”, “veto”, “companion” and “motherhood” as descriptors of the situation that attribute news-values of: relevance, due to the impact on people’s lives; conflict, as a symbolic violence; infringement, for the violation of a right; personalization, giving a character of identification of the reader with the characters - the pregnant women and the dramatization, given the symbolic and emotional dimension of birth. The opposite, however, favors the institutions that justified non-compliance with the law under prevention and give the final word.

It is reported as loss of rights from the perspective of users in news 4, 17 and 19, and in news 13, under the companion bias. This approach assigns customization newsvalue. In news 12 and 14 the perspective adopted is that of popular mobilization, attributing a character of notability, as it is a tangible fact, about what Traquina (2005TRAQUINA, N. Porque as notícias são como são. Florianópolis: Insular, 2005. (Coleção Teoria do Jornalismo, v. 1)., p. 82) says that “there has to be anything specific that has an evident form, there has to be any manifest aspect”.

Approaches that humanize the characters are resources that favor identification with the fact and empathy of the interlocutors. Spink and Gimenes (1994SPINK, M. J. P.; GIMENES, M. G. G. Práticas discursivas e produção de sentido: apontamentos metodológicos para a análise de discursos sobre a saúde e a doença. Saúde e Sociedade, São Paulo, v. 3, n. 2, p. 149-171, 1994. DOI: 10.1590/s0104-12901994000200008
https://doi.org/10.1590/s0104-1290199400... , p. 152) point out that in discursive practices of meaning production, the understanding of a self - an “I” in the narrative - implies “entering the field of rhetoric in search of argumentation and deposition of values: the revealing qualifiers of affective investment”. Spink (2004SPINK, M. J. P. (Org.). Práticas discursivas e produção de sentidos no cotidiano: aproximações teóricas e metodológicas. 3. ed. São Paulo: Cortez, 2004., p. 36) also states that “discursive practices, therefore, necessarily imply the use of repertoires and identity positions”.

In news 15 and 16, the loss is reported with institutional bias, that is, considering the actors involved in the fight for law (Public Prosecutor’s Office and Public Defender’s Office). This approach is common in journalistic texts because, according to Wolf (2002WOLF, M. Teorias da comunicação. Lisboa: Presença, 2002.), official sources confer credibility from the official point of view.

The maintenance of the right to the companion, i.e. lawsuits that resulted in favor of the right, was addressed in news 5, 6, 7, 8, 9, 10 (advertising report), 11, 18 and 20. From this approach, hospitals and maternities are often placed in the foreground, even if suffering the penalty, as for example in news 7, whose title is “Preliminary injunction of collective action of the Public Defender’s Office guarantees companion for pregnant women in Santa Casa of Mogi”. Once again, under the bias of the controversy, the final word of the institution and the actors involved on the outcome stands out, sometimes to the detriment of the well-being of the whistleblowers.

This institutionalist approach does not reflect the neutrality and exemption that the vehicle proposes and impacts on the democratic formation of public opinion in health. In this sense, Santos et al. (2022SANTOS, R. T. et al. Saúde pública e comunicação: impasses do SUS à luz da formação democrática da opinião pública. Ciência & Saúde Coletiva, Rio de Janeiro, v. 27, n. 4, p. 1547-1556, 2022. DOI: 10.1590/1413-81232022274.02622021
https://doi.org/10.1590/1413-81232022274... , p. 1550) point out that “the media gain full political meaning, whose democratization is a requirement for the construction of a health system based on the public interest”.

Argumentation

Failure to comply with the Companion Law is not restricted to the moment of the pandemic nor is it recent. In a national survey conducted in 2012, about 25% of the interviewees had no companion, slightly more than half (55.2%) had a companion at partial moments of hospitalization, and less than 20% had a companion during the entire hospitalization (DINIZ et al., 2014DINIZ, C. S. G. et al. Implementação da presença de acompanhantes durante a internação para o parto: dados da pesquisa nacional Nascer no Brasil. Cadernos de Saúde Pública, São Paulo, v. 30, p. S140-S153, 2014. Suplemento 1. DOI: 10.1590/0102-311X00127013
https://doi.org/10.1590/0102-311X0012701... ).

From the theoretical perspective adopted (Spink, 2004SPINK, M. J. P. (Org.). Práticas discursivas e produção de sentidos no cotidiano: aproximações teóricas e metodológicas. 3. ed. São Paulo: Cortez, 2004.), it is important to note that the reports always brought arguments from authorities, mainly justified in the biosafety discourse. Words such as “restrict”, “suspend” or “prohibit” were found in most publications, in reference to the withdrawal of the right. In this sense, it is interesting to observe how and what justifications are used for the suppression of the right.

News from São Paulo, Tocantins, Minas Gerais, Santa Catarina, Paraná, Paraíba and Amazonas were found, with a higher incidence in the first two. The news have in common the legal aspect, the intervention and interlocution of the Judiciary in the health context, mainly the hospital. In this context, it is worth mentioning the performance of the Public Defender’s Office and the Public Prosecutor’s Office in favor of women’s rights and that the theme - despite appearing in some reports - is not dealt with in the sphere of private law, but rather collective law.

Biosafety was the argument most used by hospitals and maternity hospitals to justify the veto, used as the main justification, although it is not explained in all the news. Solitary childbirth is justified by the need for sanitary measures.

Considering the right of the pregnant woman and the prevention and biosafety measures, in news 1, 2, 4, 7, 8, 9, 11, 12 and 14 to 20 (in this last interval the news deals with the same place - Tocantins), the prohibition of the companion was total, preventing her presence in pre-delivery, delivery and postpartum.

The entry release of the companion after delivery is described only in news 13.

The presence of the companion at the time of delivery - and his departure after - is described in news 3.

Although there was a certain delay and difficulty in organizing the management of the pandemic in Brazil, with lasting effects (Sodré, 2020SODRÉ, F. Epidemia de covid-19: questões críticas para a gestão da saúde pública no Brasil. Trabalho, Educação e Saúde, Rio de Janeiro, v. 18, n. 3, p. 1-12, 2020. DOI: 10.1590/1981-7746-sol00302
https://doi.org/10.1590/1981-7746-sol003... ), states and municipalities adopted preventive measures in several spheres.

The Ministry of Health expressed itself, in Technical Note No. 9/2020, for the maintenance of the right (Brazil, 2020BRASIL. Ministério da Saúde. Nota Técnica nº 9/2020-Cosmu/CGCIVI/Dapes/Saps/MS. Recomendações para o trabalho de parto, parto e puerpério durante a pandemia da covid-19. Brasília, DF, 10 abr. 2020. Disponível em: <Disponível em: https://bit.ly/3TvQHYU >. Acesso em: 11 set. 2021.
https://bit.ly/3TvQHYU... ). The presence of a companion represents emotional and psychological support, encouragement and advocacy³3power of argument that helps woman and partner to express their desires and needs to others in the experience of childbirth, and can improve the safety of women in childbirth, their capacity for autonomy and agency (WHO, 2014OMS - Organização Mundial da Saúde. Prevenção e eliminação de abusos, desrespeito e maus-tratos durante o parto em instituições de saúde. Genebra, 2014. Disponível em: <Disponível em: http://apps.who.int/iris/bitstream/10665/134588/3/WHO_RHR_14.23_por.pdf >. Acesso em: 12 mar 2022
http://apps.who.int/iris/bitstream/10665... ). According to Diniz et al. (2014DINIZ, C. S. G. et al. Implementação da presença de acompanhantes durante a internação para o parto: dados da pesquisa nacional Nascer no Brasil. Cadernos de Saúde Pública, São Paulo, v. 30, p. S140-S153, 2014. Suplemento 1. DOI: 10.1590/0102-311X00127013
https://doi.org/10.1590/0102-311X0012701... , p. 142), it is especially valuable in cases of serious complications, especially in the aid of emergency care, “considered an indicator of safety, quality of care and respect for women’s rights in care”.

Technical Note No. 9/2020 recommended that the companion be asymptomatic and not belong to risk groups (Brasil, 2020BRASIL. Ministério da Saúde. Nota Técnica nº 9/2020-Cosmu/CGCIVI/Dapes/Saps/MS. Recomendações para o trabalho de parto, parto e puerpério durante a pandemia da covid-19. Brasília, DF, 10 abr. 2020. Disponível em: <Disponível em: https://bit.ly/3TvQHYU >. Acesso em: 11 set. 2021.
https://bit.ly/3TvQHYU... ). However, it differentiated the moments of hospitalization into two periods: (1) before and during childbirth, and (2) after childbirth, excluding the postpartum period, whose recommendation does not depend on the SARS-Cov-2 infection status. It provided companionship only in cases of clinical instability of the parturient or in specific conditions of the newborn, as well as for the underage parturient. In other cases, it recommended temporary suspension. Therefore, the note restricted the right to the companion to the postpartum period (puerperium).

A correct interpretation of Technical Note No. 9/2020 took place in São Paulo, where the doctor in charge allowed the presence of a companion after delivery:

This different understanding of the law and the technical note by the institutions - that they would be respecting the norm if they allowed monitoring in only one period of hospitalization, in this case childbirth - shows disregard of the birth process as a biopsychosocial event and misinterpretation of the law - which informs the permission of a companion “during the entire period of labor, delivery and immediate postpartum” (Brasil, 2005BRASIL. Lei n° 11.108, de 7 de abril de 2005. Altera a Lei n. 8.080, de 19 de setembro de 1990, para garantir às parturientes o direito à presença de acompanhante durante o trabalho de parto, parto e pós-parto imediato, no âmbito do Sistema Único de Saúde - SUS. Diário Oficial da União, Brasília, DF, 8 abr. 2005. Disponível em: <Disponível em: https://www.planalto.gov.br/ccivil_03/_ato2004-2006/2005/lei/l11108.htm >. Acesso em: 28 out. 2021.
https://www.planalto.gov.br/ccivil_03/_a... ). This case exemplifies the reductionist view of the importance of the presence of someone of the woman’s choice. The companion is not a spectator of childbirth, as if it were a “product”, but is there to offer support throughout the process, in addition to the first care for the newborn, even favoring the adoption of good practices (Diniz et al., 2014DINIZ, C. S. G. et al. Implementação da presença de acompanhantes durante a internação para o parto: dados da pesquisa nacional Nascer no Brasil. Cadernos de Saúde Pública, São Paulo, v. 30, p. S140-S153, 2014. Suplemento 1. DOI: 10.1590/0102-311X00127013
https://doi.org/10.1590/0102-311X0012701... ; Monguilhott et al., 2018MONGUILHOTT, J. J. da C. et al. Nascer no Brasil: the presence of a companion favors the use of best practices in delivery care in the South region of Brazil. Revista de Saúde Pública, São Paulo, v. 52, p. 1-11, 2018. DOI: 10.11606/S1518-8787.2018052006258
https://doi.org/10.11606/S1518-8787.2018... ). This vision appears in the title of one of the articles, when it says only “to attend childbirth” (News 5).

Budget restrictions were also pointed out as the cause of the ban on companions, due to the absence of personal protective equipment (PPE) - which would allow safe entry. They are explained in news 8, 17 and 19 (the last two referring to the state of Tocantins).

Actors involved, judicialization and outcome

Judicialization was a recurring feature in the news. In Campina Grande (News 6), for example, non-compliance was not reported, but rather the request of the Public Prosecutor’s Office to safeguard women’s rights. Among the recommendations, the report highlights:

In the context of health, the activation of the Judiciary happens when there is no guarantee of the rights established by law. The main actors involved in the search for guarantees of rights were the Public Prosecutor’s Office, the Public Defenders’ Offices and people who resorted to lawyers to enforce the law:

Only one news story addressed the unfavorable decision to seek compensation, because the father could not accompany the birth - the news does not comment on the outcome. The others show the important role of public legal bodies in guaranteeing this right, including in trying to build dialogues for a consensual solution, before lawsuits:

Regarding women’s health and obstetrics, mediation by legal institutions is an increasingly reported path. Cases such as Adelir Lemos de Góes, who was removed from her home by an injunction signed by a judge and subjected to cesarean section surgery against her will (Simas; Mendonça, 2017SIMAS, R.; MENDONÇA, S. S. O Caso Adelir e o Movimento pela Humanização do Parto: Reflexões sobre violência, poder e direito. Vivência: Revista de Antropologia, Natal, v. 1, n. 48, p. 89-103, 2017. DOI: 10.21680/2238-6009.2016v1n48ID11504
https://doi.org/10.21680/2238-6009.2016v... ), show how the system and the power game between medical and legal discourses can have discrepant readings of women’s rights.

An article published in Manaus (News 10) about a bill to ensure pregnant women the right to a companion draws attention. The author of the law commented that the objective is to guarantee this right even in situations of calamity.

In this case, the restriction on the companion motivated a bill that sought to legislate on a right already guaranteed for more than 15 years.

In Brazil, a country with high rates of violations at the time of childbirth, with interventionist assistance (Leal et al., 2014LEAL, M. C. et al. Intervenções obstétricas durante o trabalho de parto e parto em mulheres brasileiras de risco habitual. Cadernos de Saúde Pública , São Paulo, v. 30, p. S17-S32, 2014. Suplemento 1. DOI: 10.1590/0102-311X00151513
https://doi.org/10.1590/0102-311X0015151... ), the figure of the companion is a protective factor for women (WHO, 2014OMS - Organização Mundial da Saúde. Prevenção e eliminação de abusos, desrespeito e maus-tratos durante o parto em instituições de saúde. Genebra, 2014. Disponível em: <Disponível em: http://apps.who.int/iris/bitstream/10665/134588/3/WHO_RHR_14.23_por.pdf >. Acesso em: 12 mar 2022
http://apps.who.int/iris/bitstream/10665... ). In this sense, the loss of this right in the pandemic results in obstetric violence. According to the World Health Organization (WHO), “pregnancy is not interrupted in a pandemic, nor are fundamental human rights. The experience of a woman’s childbirth is as important as her clinical care” (WHO, 2020WHO - WORLD HEALTH ORGANIZATION. Every woman’s right to a companion of choice during childbirth. [ WHO News], Geneva, 9 set. 2020. Disponível em: <Disponível em: https://www.who.int/news/item/09-09-2020-every-woman-s-right-to-a-companion-of-choice-during-childbirth >. Acesso em: 28 out. 2021.
https://www.who.int/news/item/09-09-2020... ).

Previous research has already shown how this is a disrespected right, including pointing out the inequality in power relations between health professionals and the traditional structures of institutions as “issues” that directly influence the effectiveness or not of this right (Rodrigues et al., 2017RODRIGUES, D. P. et al. O descumprimento da Lei do Acompanhante como agravo à saúde obstétrica. Texto & Contexto Enfermagem, Florianópolis, v. 26, n. 3, e5570015, 2017. DOI: 10.1590/0104-07072017005570015
https://doi.org/10.1590/0104-07072017005... ).

Tocantins Case

The news about Tocantins (2, 14, 15, 16, 17, 18, 19 and 20) report a problematic scenario, since the ban on the companion came from the State Health Secretariat (SES-TO) and lasted longer: from April 2020 to April 2022. In April 2020 (News 2) it is reported that the Public Defender’s Office filed a lawsuit questioning the decision, which violated the recommendations of the Ministry of Health and WHO.

The mobilizations for the resumption of the right are described from News 14, of November 19, 2020. The SES-TO restriction covered 18 state hospitals. On July 27, 2021, the demand of women for the return of the right was reported again (News 15). At that time, court hearings were being held with SES-TO itself, the Public Defender’s Office and the Public Prosecutor’s Office.

As of News 16, of August 27, 2021, it is reported that the Court of Tax Enforcement and Health of Palmas partially met the requests of the Defender’s Office and established a deadline for the State to present a recovery plan with structural planning. Transitional measures were determined to ensure the presence of companions during labor, including the presentation of a negative RT-PCR test for covid-19. But it is reported difficulty in accessing the RT-PCR exam, with little availability in the state public network (News 17).

News 18, 19 and 20, published between September 2021 and April 2022, describe SES-TO’s slowness and inefficiency in disclosing and implementing the resumption plan, especially the RT-PCR testing of companions. These difficulties became new barriers, until the normalization of the right, in 2022.

In all news, SES-TO’s justification for prohibiting or restricting companion access in pre-delivery, childbirth and post-delivery was justified by biosecurity issues, allegedly supported in its contingency plan, superimposed on the law.

Final considerations

The newsworthiness of the reproductive rights theme followed the logic of the controversy by adopting the biases of loss or maintenance of the right, which conferred dramatic value and personalization of the news. When adopted, institutional bias reinforced the credibility of official sources, sometimes to the detriment of complaints. There was little room for debate about the perspective of those who suffer the most from the consequences of these arbitrariness: women.

There was a discrepancy in relation to the interpretation of the law in several municipalities and states, despite the clear position of the WHO informing the guarantee of women’s rights and emphasizing that the pandemic is not an exception. In the Brazilian scenario, the Ministry of Health, as a higher authority, and several legal bodies issued opinions and protocols reaffirming the right to the presence of a companion. In some places, in addition to non-compliance with the law, even the measures that reiterated the maintenance of the right were not complied with.

The restriction in Tocantins lasted until May 2022 and the decision came from SES-TO, allegedly justified by recommendations from the WHO and Ministry of Health. But it is worth noting that since April 2020 the two entities have published several protocols that recommended the maintenance of a companion. Thus, in this case, the generalist argument reflected the inflexibility of the institution and caused harm to pregnant women. The health system, represented by SES, failed to update itself on the protocols and practices proposed in response to the pandemic, and also to dialogue with users of the health service.

Stoffel et al. (2021)STOFEL, N. S. et al. Perinatal care in the COVID-19 pandemic: analysis of Brazilian guidelines and protocols. Revista Brasileira de Saúde Materno Infantil, Recife, v. 21, pp. 89-98, 2021. Suplemento 1. DOI: 10.1590/1806-9304202100S100005
https://doi.org/10.1590/1806-9304202100S... , when analyzing Brazilian protocols, highlight the importance of recognizing demands and particularities of each situation. The issue of race/color, class, and location was decisive for the number of maternal deaths in the covid-19 pandemic (Alves et al., 2022ALVES, R. P. et al. Maternal mortality in times of the COVID-19 pandemic: An integrative review. Research, Society and Development, [s. l.], v. 11, n. 4, p. 1-8, 2022. DOI: 10.33448/rsd-v11i4.26942
https://doi.org/10.33448/rsd-v11i4.26942... ), making clear the vulnerability of Brazilian women in obstetric care.

The chronology of the news draws a parallel between the demands of pregnant women and the intransigence of the State, inefficient in supporting pregnant and parturient women at a time of so much fragility, such as childbirth, in such a frightening pandemic context.

References

Publication Dates

History