ORIGINAL ARTICLE
MATERNAL AND CHILD NURSING FROM THE PERSPECTIVE OF CHILD HEALTH BLACK POPULATION: THEMATIC INCLUSION ANALYSIS
ENFERMERÍA MATERNO-INFANTIL DESDE LA PERSPECTIVA DE LA SALUD INFANTIL POBLACIÓN NEGRA: ANÁLISIS DE INCLUSIÓN TEMÁTICA
A ENFERMAGEM MATERNO-INFANTIL NA PERSPECTIVA DA SAÚDE DA POPULAÇÃO NEGRA: ANÁLISE DE INCLUSÃO TEMÁTICA
https://doi.org/10.31011/reaid-2025-v.99-n.4-art.2468
1Brenda Leticia Castro de Oliveira
2Pâmela Correia Castro
3Raíssa Moura de Almeida
4Nádile Juliane Costa de Castro
1Universidade Federal do Pará - UFPA, Castanhal, Brazil, ORCID: https://orcid.org/0009-0009-2439-9849
2Universidade Federal do Pará - UFPA, Belém, Brazil, ORCID: https://orcid.org/0000-0001-9027-7932
3Universidade Federal do Pará – UFPA, Belém, Brazil, ORCID: https://orcid.org/0009-0001-3515-4785
4Universidade Federal do Pará - UFPA, Belém, Brazil, ORCID: https://orcid.org/0000-0002-7675-5106
Corresponding Author
Nádile Juliane Costa de Castro
Rua Augusto Corrêa, 937, Guamá, Belém – PA – Brazil. 66075110; contact: +55(91) 3201-7266; E-mail: nadiledecastro@ufpa.br.
Submission: 13-01-2025
Approval: 30-05-2025
ABSTRACT
Introduction: Maternal and child health in Brazil faces racial disparities, reflecting institutional racism and highlighting the need for a more equitable approach in the SUS. Therefore, it is imperative to include ethnic-racial themes in undergraduate course curricula. Objective: to analyze curricular activities in the maternal and child area, relating them to health care for the black population. Method: qualitative, descriptive and documentary study, aiming to promote a thematic analysis of data from the Pedagogical Political Project of an undergraduate Nursing course at a federal public higher education institution in the Northern Region of Brazil, based on the syllabi and teaching plan of two curricular activities. Results: the following descriptive sequence was obtained: trajectory of the Black Movement, with emphasis on health issues, based on a timeline; dimensions and subdimensions of each of the competencies, related to maternal and child health of the black population; characterization of the curricular activities under examination; descriptive elements of educational and health policies; and bibliographic references used. Conclusion: The investigation showed a limited incorporation of ethnic-racial content, revealing a significant gap in the training of future professionals in the area. This finding highlights the urgent need for curricular reformulations that promote more inclusive and anti-racist education.
Keywords: Nursing; Black Population; Ethnic and Racial Minorities; Maternal and Child Health; Nursing Education.
RESUMEN
Introducción: La salud materna e infantil en Brasil enfrenta disparidades raciales, lo que refleja el racismo institucional y destaca la necesidad de un enfoque más equitativo en el SUS. Por lo tanto, es imperativo incluir temas étnico-raciales en los planes de estudio de los cursos de pregrado. Objetivo: analizar las actividades curriculares en el área materno infantil, relacionándolas con la atención a la salud de la población negra. Método: estudio cualitativo, descriptivo y documental, con el objetivo de promover el análisis temático de los datos del Proyecto Político Pedagógico de una carrera de graduación en Enfermería de una institución de educación superior pública federal de la Región Norte de Brasil, a partir del programa y plan de enseñanza de dos actividades curriculares. Resultados: se obtuvo la siguiente secuencia descriptiva: trayectoria del Movimiento Negro, con énfasis en temas de salud, a partir de una línea de tiempo; dimensiones y subdimensiones de cada una de las competencias, relacionadas con la salud maternoinfantil de la población negra; caracterización de las actividades curriculares objeto de examen; elementos descriptivos de políticas educativas y de salud; y referencias bibliográficas utilizadas. Conclusión: La investigación mostró una limitada incorporación de contenidos étnico-raciales, revelando un vacío importante en la formación de futuros profesionales del área. Este hallazgo resalta la necesidad urgente de reformulaciones curriculares que promuevan una educación más inclusiva y antirracista.
Palabras clave: Enfermería; Población Negra; Minorías Étnicas y Raciales; Salud Maternoinfantil; Educación en Enfermería.
RESUMO
Introdução: A saúde materno-infantil no Brasil enfrenta disparidades raciais, refletindo o racismo institucional e destacando a necessidade de uma abordagem mais equitativa no SUS. Assim, é imperativo incluir a temática étnico-racial nos currículos dos cursos de graduação. Objetivo: analisar as atividades curriculares da área materno-infantil, relacionando-as à atenção em saúde da população negra. Método: estudo qualitativo, descritivo e documental, visando promover uma análise temática de dados do Projeto Político Pedagógico de um curso de graduação em Enfermagem de uma instituição pública federal de ensino superior da Região Norte do Brasil, a partir das ementas e do plano de ensino de duas atividades curriculares. Resultados: obteve-se a seguinte sequência descritiva: trajetória do Movimento Negro, com destaque para questões de saúde, a partir de uma linha do tempo; dimensões e subdimensões de cada uma das competências, relacionadas à saúde materno-infantil da população negra; caracterização das atividades curriculares em exame; elementos descritivos das políticas educacionais e de saúde; e referências bibliográficas utilizadas. Conclusão: A investigação evidenciou uma incorporação limitada de conteúdos étnico-raciais, revelando uma lacuna significativa na formação dos futuros profissionais da área. Essa constatação destaca a necessidade urgente de reformulações curriculares, que promovam uma educação mais inclusiva e antirracista.
Palavras-chave: Enfermagem; População Negra; Minorias Étnicas e Raciais; Saúde Materno-Infantil; Educação em Enfermagem.
INTRODUCTION
Maternal and child health care represents one of the fundamental pillars for the development of healthy and resilient societies, and it is essential for achieving global goals¹. It is known that the effectiveness of this support is weakened when the complexity of interactions between social and health determinants is not considered², and there are also racial disparities, which pose a critical challenge and reflect the deep inequities within the health system³. These issues are rigorously discussed within the structures of the Brazilian Unified Health System (SUS), given the significant proportion of Black people who access health services in the country²,⁴.
To understand this scenario, it is necessary to consider the concept of institutional racism, which refers to racism present within institutions⁵. This concept helps reveal how practices, policies, and norms perpetuate inequalities that disproportionately affect the Black population⁴, and it highlights how, in maternal and child health care, these inequities manifest through differences in access⁴, quality of care, and health outcomes, underlining the need for critical, change-oriented analysis⁶. Therefore, incorporating an ethno-racial perspective into health policies and professional training is essential, as it fosters a more holistic understanding of the health needs of the Black population and encourages practices aimed at equity and social justice⁶,⁷.
It is important to recognize the multiple initiatives and entities that, within the field of ethno-racial relations, work to support policies such as the National Policy for the Comprehensive Health of the Black Population (PNSIPN). Although the PNSIPN was developed within the scope of the SUS and based on its principles of universality, integrality, and equity, its formulation also reflects a history of social mobilization that includes, but is not limited to, the Black Movement⁸,⁹. This term encompasses a diversity of actors, actions, and contexts working toward racial equity and the promotion of rights⁸.
However, it is essential to understand the PNSIPN as a public policy directly linked to the structure and guiding principles of the SUS, rather than merely the result of external social actions²,³,⁴. These initiatives provide a backdrop for understanding current and future practices in maternal and child health care while emphasizing the need to situate the PNSIPN within the broader context of the SUS and Brazilian public health policies, avoiding oversimplifications that detach the policy from its territorial and intersectoral foundations.
Among health professionals working in this context as part of the SUS workforce, Nursing stands out for its significant role¹⁰. In this light, it is important to discuss the inclusion of racial issues within the National Curriculum Guidelines for undergraduate Nursing programs (DCN/ENF). These guidelines shape the training of professionals; therefore, they must be considered alongside the PNSIPN to ensure that the skills and competencies they describe are developed in alignment with racial and social markers, in order to confront institutional racism in health services beginning at the training level⁶,¹¹.
This represents a commitment to combating racism and eliminating racial disparities, ensuring equitable access to health care and contributing to the construction of just and inclusive societies¹,¹². It also aligns with the training of professionals who can address these issues¹¹ by identifying problems and proposing solutions to reduce health inequities through actions in maternal and child health.
Moreover, educational institutions must reflect on how to respond to the specific needs of this population. Therefore, incorporating ethno-racial content in Nursing education is an important step toward this goal. This can be guided by the DCN/ENF and shaped by the surrounding context of racial issues¹,¹¹. Identifying specific content can reveal the need for curriculum and pedagogical adjustments, a challenge that includes breaking with colonial models that reinforce racist structures and instead moving toward social transformation¹³.
Thus, studies that support the idea of curricular reform¹³ are needed, studies that assess alignment between curricula and defined educational goals and seek to understand how curricula relate to social, cultural, and economic contexts⁷,¹³. This includes examining how the curriculum prepares students for citizenship⁷, especially for groups experiencing social vulnerability¹⁵, and what evidence supports curricular changes that promote reflective and responsive practices addressing the needs of the Black population¹⁴. Such studies pave the way for structural change, strengthening the SUS and combating racism in its many layers¹⁶.
In this context, the following research question was posed: How are ethno-racial themes related to the health of the Black population included in maternal and child Nursing activities at a public university in the Northern Region of Brazil? The objective of this investigation was to evaluate curricular activities in the area of Nursing that address maternal and child care, relating them to health care for the Black population.
METHOD
This is a qualitative, descriptive, and documentary study, involving a detailed analysis of documents relevant to understanding the practices, policies, and theories that influence the curriculum. This includes, but is not limited to, syllabi, course programs, teaching materials, institutional regulations, and evaluation reports¹⁷.
As the data source, the Political-Pedagogical Project (PPP) of a Nursing program from a public higher education institution located in the Metropolitan Region of Belém, in the state of Pará (Northern Brazil), was examined. The program offers 84 authorized seats, according to the Ministry of Education’s electronic platform (e-MEC), and its most recent score on the National Student Performance Exam (ENADE) was 3. The institution has offered affirmative action seats for Black students since 2005, based on Resolution No. 3.361 of its Higher Council for Teaching, Research, and Extension (Consepe). It also conducts a Special Selection Process (PSE) for quilombola populations, offering an average of two seats per year to this group.
For this investigation, the following curricular activities (CAs) were considered: Nursing in Women’s Health in Primary Health Care (ESMAPS); and Nursing in the Health of Children and Adolescents in Primary Health Care (ESCAAPS). These activities have total workloads of 150 and 120 hours, respectively, of which 60 and 45 hours are dedicated to theory, 60 and 60 hours to practical classes, and 15 hours to extension activities.
Data collection occurred between November 2023 and January 2024. Initially, the PPP and reference documents were reviewed, including the National Curriculum Guidelines for undergraduate Nursing programs (DCN/ENF); the National Curriculum Guidelines for the Education of Ethnic-Racial Relations (DCNERER); and the National Policy for the Comprehensive Health of the Black Population (PNSIPN), in order to identify references supporting key points in health care for the Black population.
In the first stage, the data collection instrument was developed considering the following CA elements: skills and competencies; workload; syllabus; objectives; and specific references. Subsequently, information was selected based on ethical and humanistic elements and thematic approaches related to the health of the Black population. These were organized in a Microsoft Word document and then analyzed to support the presentation of results using graphic editors.
Data were analyzed using Content Analysis¹⁸, resulting in the establishment of three categories:
1. Black Movement and health of the Black population in Nursing education (category 1);
2. Development of competencies and skills with ethno-racial interfaces in maternal and child care within Nursing education (category 2);
3. Ethno-racial relations in curricular organization and content (category 3).
Paulo Freire and bell hooks were adopted as theoretical foundations¹⁹,²⁰. In his seminal work Pedagogy of the Oppressed, Freire presents education as a practice of freedom, proposing a pedagogical method that positions students as co-creators of knowledge in a dialogical process that transcends the mere transmission of content. He argues that education must be emancipatory, enabling individuals to critically question social reality and act as agents of change in their communities¹⁹.
Bell hooks, in turn, complements and expands this perspective by emphasizing intersectionality and critical consciousness in education. She proposes an engaged pedagogy that recognizes students’ diverse identities and the influence of factors such as race, gender, and social class on the learning process. Hooks advocates for a transformative education capable of challenging existing power structures and promoting social equality and justice, highlighting education as a tool for social transformation²⁰.
RESULTS
The results are presented in descriptive sequence. When considering the trajectory of political struggle by the Black Movement between 1988 and 2011, one can observe its close relationship with fundamental issues in health and education, as illustrated in Figure 1.
Figure 1 – Timeline of health, education, and Black Movement legislation.
Source: Prepared by the authors (2024).
With regard to competencies and skills for working in the maternal and child health field, Articles 5 (VII) and 6 (III) of the DCN/ENF establish that these may be expressed through elements present in policies, as illustrated in Figure 2.
Figure 2 – Concept map of the dimensions and sub-dimensions of competencies related to maternal and child health and the health of the Black population.
Source: Prepared by the authors (2024).
The figure illustrates ten elements that characterize skills to be strengthened, which in practice represent aptitudes and recognition of knowledge and practices related to diversity, plurality, and singularity, as well as cognitive and learning processes. To understand how these elements are included in ESMAPS and ESCAAPS, a summary table (Table 1) was developed.
Table 1 – Characterization of curricular activities in the maternal and child Nursing area, 2024.
|
CA |
SEM CH |
Syllabus |
|
ESCAAPS |
6th |
Historical, cultural, social, and legal aspects of child and adolescent health care. Interface between comprehensive child and adolescent care and Nursing practice. Adolescent and school health. Nursing consultation and humanized care for children and adolescents. Vulnerabilities and risks to child and adolescent health. |
|
ESMAPS |
6th |
Policy for comprehensive women's health care. Integrality of women’s health in the pregnancy–puerperal cycle, sexual and reproductive health. Nursing care for women victims of violence. Nursing care for women with breast and cervical cancer. Nursing care for women in climacteric and menopause. Nursing consultation with humanized care. Vulnerabilities among groups of women and Nursing care needs. |
Source: Political-Pedagogical Project (2020).
To highlight relevant elements of the PPP and related policies and to support a combined analysis, a word cloud was created (Figure 3).
Figure 3 – Word cloud with descriptors related to the objectives of the PNSIPN, the DCN/ENF, and the syllabi and objectives of the curricular activities.
Source: Prepared by the authors (2024).
DISCUSSION
The analysis revealed a limited inclusion of ethno-racial themes⁶ in the curricular activities of this Nursing program, especially concerning maternal and child health for the Black population. This finding is significant given that equity in health is a founding principle of the SUS and a fundamental right¹. Likewise, from an equity standpoint, there is an observable deficit in the training of health professionals with the competencies needed to address racial issues²,³,⁴.
The absence of these themes in the syllabi and teaching plans analyzed may reflect the coloniality of curricula²¹, which runs counter to the integration of public health policies into Nursing education, such as the PNSIPN. This misalignment between political guidelines and professional training creates a gap between educational commitments to promoting racial equality⁶ and their practical expression within health care.
The results also highlighted the importance of the Black Movement and public policy development⁹ in combating racial disparities in health²,³ and shaping educational policies over time⁹. The influence of these initiatives on Nursing education guidelines is evident and aligns with the inequities²,³,⁴ affecting the health of the Black population⁸ and the mechanisms developed to confront them¹⁶,²¹.
However, this influence is scarcely reflected in the analyzed teaching plans. Instead, traditional content predominates, with little emphasis on cultural contextualization and the specificities of Black population health¹¹,¹², reflecting the persistence of hegemonic identities²¹. This pattern points to an educational approach that neglects the social and cultural complexities²² shaping health experiences among ethnic and racial minorities¹⁴,²³, and underscores the need for curricular revision⁶ that explicitly incorporates social determinants of health²², particularly race²²,²³.
The discussion proceeds through the rest of the document, including public policy implications, curricular reform needs, teacher training, antiracist pedagogical practices, and structural barriers in Nursing education.
FINAL CONSIDERATIONS
The investigation evidenced a limited incorporation of ethno-racial content, revealing a significant gap in the training of future professionals. This finding highlights the urgent need for curricular reform to promote a more inclusive and antiracist education aligned with PNSIPN and DCN/ENF guidelines.
The study also underscores the importance of social movements, especially the Black Movement, in promoting racial equality and combating health inequities, and it points to the need for institutional commitment toward effectively including ethno-racial content in Nursing curricula. Such an initiative would meet the social and health demands of the Black population and contribute to training health professionals who are more aware, critical, and capable of acting as agents of social change.
The study was limited to two subareas, indicating the need to examine others related to them. Thus, it emphasizes the importance of analyzing midwifery curricula through racial markers and reviewing research on maternal and child health references for Black populations and on training for antiracist Nursing practices.
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Funding and Acknowledgments:
This research received no funding.
Authorship Criteria (Author Contributions)
Brenda Leticia Castro de Oliveira contributed substantially to the conception and planning of the study, data acquisition, analysis and interpretation, as well as the writing, critical review, and final approval of the published version.
Pãmela Correia Castro contributed substantially to the conception and planning of the study, data acquisition, analysis and interpretation, as well as the writing, critical review, and final approval of the published version.
Raíssa Moura de Almeida contributed substantially to the conception and planning of the study, data acquisition, analysis and interpretation, as well as the writing, critical review, and final approval of the published version.
Nádile Juliane Costa de Castro contributed substantially to the conception and planning of the study, data acquisition, analysis and interpretation, as well as the writing, critical review, and final approval of the published version.
Conflict of Interest Statement
Nothing to declare
Scientific Editor: Ítalo Arão Pereira Ribeiro. Orcid: https://orcid.org/0000-0003-0778-1447
Rev Enferm Atual In Derme 2025;99(4): e025162
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