How black women reclaimed care in São Paulo

*This name has been changed to protect anonymity.

In 2020, a group of black women psychologists opened Casa de Marias in São Paulo, Brazil, for mothers like Ana and other women who needed culturally sensitive care. It’s a centre focused on meeting the mental health demands of women who carry in their minds and bodies the layers of structural oppression they experience every day. On average, we make a thousand consultations a year. We know that these women sit at the bottom of the Brazilian social pyramid and, as a consequence of the oppression from being in this position, they are also the population group that gets sick the most. That’s why, in our view, caring for them is also a political decision.

We are inspired by the practice of what Brazilians call aquilombamento: creating a space that is intentionally and recognisably by and for black Brazilians and centres this community’s knowledge and customs. Beyond physical space, it is a political and cultural movement that involves the creation of support networks, the preservation of memory, and the affirmation of black identity in all its dimensions. Doing this, we have learned, is essential for dealing with the psychological suffering of black women. Our culturally informed programming allows them to feel seen, and find ways to express their pain. Through these intimate connections, we are able to create powerful support networks among the participants, and Casa de Marias has become a space for effective mental health improvement for these women, who have historically been excluded from access to care spaces.

Impact of living in urban peripheries

Casa de Marias is located in the most populous part of São Paulo, in the Penha neighbourhood. Penha is considered a peripheral neighbourhood, where many residents face economic challenges and have limited access to services. Known as a hard-working community, living in Penha means experiencing higher rates of violence and systemic racism. According to data from the 2023 Inequality Map for São Paulo (Instituto Cidades Sustenáveis and Rede Nossa São Paulo, 2023) this territory has around 129,000 inhabitants, with a female population of 53.3% and a black and brown population of 23.9% – given the complexity of racial perceptions in Brazil, this percentage is likely to be higher. The area has five public mental health centres, which is nowhere near enough to meet the demand. It is very complicated to make an appointment, and the centres are difficult for many to reach by public transport. Additionally, these centres often fail to give racially sensitive care, and the providers working there are often not trained in the psychological impact of motherhood.

Photo: Patricia Santos

Women in vulnerable situations are significantly underserved by the current system when it comes to their psychological health. These vulnerabilities include poverty, proximity to violence, sexism and racism. The neighbourhoods they live in lack things like public lighting, sidewalks in good condition, and safe and efficient public transport, which makes daily life more precarious and potentially dangerous. All of these factors tend to make pregnancy and new motherhood far more stressful than they would be in better circumstances.

“Women in vulnerable situations are significantly underserved by the current system when it comes to their psychological health.”

In addition to these stressors, black women in Brazil face disproportionately high maternal mortality rates and more complications during childbirth. According to Brazil’s Ministry of Health (2023), black women are more than twice as likely to die from pregnancy- related causes as white women. Research suggests that this is the result of the systemic racism that affects access to and quality of healthcare. It is common for black women to be seen as capable of enduring more pain than white women during childbirth, and therefore they do not receive proper care. Often their suffering is minimised by healthcare professionals, who believe that they are warriors and can endure anything.

Reclaiming care through aquilombamento

Casa de Marias is a welcoming space, and a space for listening. With the help of the women we serve, we provide individual and group clinical therapy, as well as artistic, cultural and coexistence projects, which are all designed to promote mental health in our community. Initiatives range between individual and group, and short-term and long-term interventions, all with the goal of responding to our community’s needs.

Programmes include Sons de Marias, a music therapy group for black women, which provides space for emotional expression and group bonding. Women are offered a choice of musical instruments, and our music therapists invite them to engage in a variety of ways. There are times for free expression, and for playing familiar songs together. Women are also free to sing, play, dance, and even compose and improvise new melodies. After this collective musical experience, women talk about how they felt and often share life experiences.

Reescritas offers a therapeutic writing group for women, in which women are prompted to write about their lives and feelings; Roda de Pretin encourages the whole family to meet together as a unit and offers time for connection and stress relief; and As Marias do Mundo provides a welcoming support programme for immigrant women. We also have an Emergency Reception Group, which provides immediate support during critical moments of crisis, to which mothers bring their fears and insecurities, often related to financial instability.

The networks that are created through our programmes are fundamental for women, for their survival and for building a sense of community in the midst of adversity. We understand the importance of support and sisterhood among black women as a strategy of resistance, and strengthening this in their lives improves their mental health and their sense of confidence and security as mothers. Casa de Marias is a place where black mothers can take a breath, heal and grow.

All references can be found in the PDF version of this article.