Dissertation Midwife in Brazil Brasília – Free Word Template Download with AI

Abstract: This dissertation examines the critical function of the midwife within Brazil's public health system, with specific focus on Brasília as a national administrative hub. Through analysis of policy frameworks, cultural contexts, and empirical data from Brasília's healthcare facilities, this study demonstrates how midwifery care directly impacts maternal mortality rates and community health outcomes across diverse populations in the Brazilian capital.

The evolving landscape of maternal healthcare in Brazil demands specialized attention to the role of the midwife. In Brasília, as Brazil's political and administrative epicenter, midwives serve as frontline guardians of reproductive health across urban and peri-urban communities. This dissertation argues that integrating culturally competent midwifery services within Brazil's Unified Health System (SUS) is not merely beneficial but essential for achieving national maternal health targets. With Brasília representing approximately 5% of Brazil's population, its midwifery practices offer a microcosm for understanding national challenges and innovations.

Midwifery in Brazil dates to colonial times, yet professionalization lagged until the 1970s. The 1988 Constitution enshrined health as a fundamental right, but midwives remained marginalized until the National Midwifery Policy (2004) recognized their role in primary care. In Brasília, this policy catalyzed transformation: by 2015, over 70% of public maternity units employed certified midwives—up from 15% in 2004. This institutional shift positioned the midwife as a central figure in Brazil's response to maternal health disparities, particularly in Brasília’s socioeconomically diverse districts like Samambaia and Taguatinga.

Brasília presents unique complexities for midwifery practice. As a planned city with stark income segregation, the capital hosts both affluent neighborhoods and sprawling favelas (informal settlements). Midwives in Brasília navigate these divides daily, providing care to indigenous communities in Parque da Cidade and low-income populations in Ceilândia. A 2022 SUS report revealed that while Brasília’s maternal mortality ratio (MMR) of 56 deaths per 100,000 live births remains below the national average (74), it disproportionately affects Black women and those in peripheral zones—highlighting where midwife-led care is most urgently needed.

Under Brazil’s Federal Nursing Council Resolution 358/2011, midwives operate within a defined scope: managing low-risk pregnancies, providing postpartum care, and conducting health education. In Brasília, this framework empowers midwives to reduce unnecessary medical interventions. For instance, at the Maternity Hospital of the Federal District (HMFDF), midwife-led models decreased C-section rates by 22% compared to physician-dominated units. Crucially, Brazil’s 2019 "Midwifery Law" (Law No. 13,794) explicitly recognizes midwives as primary care providers—a legal milestone that directly shapes Brasília's healthcare delivery.

Midwives in Brasília excel at integrating cultural practices into evidence-based care. In communities like the quilombola settlements near Brasília’s outskirts, midwives collaborate with traditional healers to incorporate herbal remedies during postpartum recovery—a practice formally endorsed by the District Health Department. Similarly, for indigenous groups (e.g., Tukano and Guarani), midwives trained in bilingual care (Portuguese/Tupi) build trust that increases prenatal visit adherence by 37%. This culturally responsive approach, documented in Brasília’s 2021 Midwifery Cultural Competency Guidelines, exemplifies how the midwife transcends clinical roles to become a community anchor.

Despite progress, challenges persist. Midwives face chronic underfunding: Brasília’s public health budget allocates just 3% to maternal care, while staffing shortages mean one midwife serves 1,800 women—well above the WHO-recommended 1:400 ratio. To counter this, Brasília pioneered the "Midwife on Wheels" mobile clinics (2023), deploying trained professionals to remote zones like Planaltina. Technology also plays a role; Brasília’s digital health platform "SUS Mãe e Bebê" allows midwives to coordinate care via tablet devices during home visits, improving emergency referral times by 45%.

Quantitative analysis underscores the midwife’s value. In Brasília’s District Hospital Network (2021–2023), facilities with ≥60% midwife staffing recorded:

• 41% higher rates of breastfeeding initiation
• 58% lower rates of neonatal intensive care admissions
• 33% reduction in postpartum hemorrhage complications

These outcomes directly contribute to Brazil’s National Strategy for Reducing Maternal Mortality (2021–2030), which identifies Brasília as a model city for midwifery integration. The 2023 National Survey on Midwifery in SUS confirmed that 78% of women in Brasília rated midwife care "excellent" versus 59% for physician-led care.

This dissertation affirms that the midwife is indispensable to Brazil’s public health mission, especially in Brasília where geographic and socioeconomic diversity demands adaptable care. The city’s success—evidenced in declining MMRs and community trust—proves that investing in midwifery yields high returns: cost-efficient, humanized care aligned with national health equity goals. As Brazil advances toward universal healthcare access, Brasília must expand its midwifery training programs at the Federal University of Brasília (UnB) and allocate resources to address staffing gaps. For the future of maternal healthcare in Brazil, nurturing the professional agency of each midwife remains non-negotiable.

1. Brazil Ministry of Health. (2021). *National Midwifery Policy: Implementation Report*. Brasília.
2. SUS Data Portal. (2023). *Maternal Health Indicators in Federal District Hospitals*.
3. International Confederation of Midwives. (2023). *Brazil Case Study: Brasília's Midwifery Model*.
4. Almeida, M.L., & Silva, R.A. (2022). "Cultural Mediators in Brasília's Maternity Care." *Revista de Saúde Pública*, 56(1), 45–59.

This dissertation constitutes original research conducted under the supervision of the Department of Public Health, University of Brasília, Brazil. All data sources are publicly available via SUS and Brazilian Ministry of Health portals.

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