[pt] A dissertação enfoca o racismo obstétrico e suas dimensões históricas e sociais no contexto brasileiro, especialmente seu impacto na maternidade das mulheres negras, abordando os efeitos psicológicos persistentes desde a gestação até o pós-parto. A pesquisa busca compreender como as experiências de racismo obstétrico influenciam a construção da maternidade das mulheres negras bem como analisa a relação entre a mãe e o filho após possíveis traumas obstétricos, explorando os aspectos psicológicos envolvidos. A abordagem metodológica foi fundamentada nos princípios da Psicologia Narrativa, que destaca a relevância das histórias na construção da identidade e da experiência humana. A psicologia contribui para uma compreensão mais completa e contextualizada do racismo obstétrico no Brasil. Este fenômeno, que se manifesta por meio de práticas discriminatórias e racismo obstétrico direcionadas a mulheres negras, tem sido pouco abordado nos âmbitos acadêmico e literário. A ausência de conhecimento e discussões sobre o racismo obstétrico contribui para a perpetuação de desigualdades raciais e para a invisibilidade das experiências das mulheres negras no contexto da assistência ao parto. Portanto, há uma urgente necessidade de mais pesquisas e estudos abrangentes sobre o tema, a fim de ampliar a conscientização e valorização destas mulheres, garantindo uma assistência obstétrica justa e igualitária para todas. / [en] The thesis focuses on obstetric racism and its historical and social dimensions in the Brazilian context, especially its impact on black women s motherhood, addressing lingering psychological effects from pregnancy to postpartum. The research seeks to understand how experiences of obstetric racism influence the construction of motherhood for black women, as well as analyzing the relationship between mother and child after possible obstetric traumas, exploring the psychological aspects involved. The methodological approach was grounded in the principles of Narrative Psychology, which emphasizes the relevance of stories in the construction of identity and human experience. Psychology contributes to a more complete and contextualized understanding of obstetric racism in Brazil. This phenomenon, which manifests itself through discriminatory practices and obstetric violence directed at black women, has been little addressed in academic and literary fields. The absence of knowledge and discussions about obstetric racism contributes to the perpetuation of racial inequalities and invisibility of black women s experiences in the context of childbirth care. Therefore, there is an urgent need for more comprehensive research and studies on the topic, in order to increase awareness and appreciation of these women, ensuring fair and equal assistance.

In this dissertation, I aim to examine how policy packages focusing on improving reproductive conditions impact adverse maternal outcomes at the local level. I use the National Institute of Reproductive Health’s Local Reproductive Freedom Index (NIRH LRFI) to advance scholarship and policy advocacy on how policies included in that index may lessen the overall maternal mortality rate while also perhaps diminishing the disparity in maternal mortality between women of color and white women in 50 major U.S. cities. I argue that policy may be an effective—though under-studied—avenue for reducing the risk of maternal mortality because policies can be used to target specific social factors that research has demonstrated place individuals at higher risk of a negative outcome. However, these policy avenues usefully can be considered as interconnected policy packages rather than merely as single-policy interventions. Additionally, current research in this area suggests that there is a clear need for more research that combines SDH with policies aimed at improving health outcomes for reproducing individuals, particularly for communities of color (Creanga et al. 2015b; Kozhimannil, Vogelsang, and Hardeman 2015; Osypuk et al. 2015). As such, I situate maternal mortality, and specifically racial disparities in maternal mortality, among social determinants of health. Overall, I argue that to successfully decrease aggregate maternal mortality rates and lessen racial disparities in reproductive health, it is essential to center the experiences and needs of women of color and use a critical lens when evaluating measures assessing reproductive freedom.