Crime as urban health governance: Evidence from prenatal health access in Brazil

• In Event: Medical Sociology Section Roundtables
  In Refereed Roundtable (90 minute): Table 6. Reproductive and Women's Health

Abstract

In this paper, I investigate how different policies adopted by organized crime (OC) groups shape access to prenatal care in Rio de Janeiro. Ethnographic and theoretical literature point to the ways in which OC establishes governance in cities and enforces rules, but more quantitative evidence is needed to show how different policies and governance practices adopted by these groups affect movement in the city. To fill this gap, I leverage the institutional difference between two classes of organized crime in Rio: drug gangs, which exert tight territorial and movement controls, and milícias, which have a less restrictive approach to movement in their territories. Using administrative records from the city and a public OC map constructed with 911 calls, I show how the geographical arrangement of OC groups and their different institutional characteristics shape access to prenatal healthcare. After statistical controls, an increase in areas dominated by drug gangs was associated with a decrease in the number of prenatal visits, while milícias were associated with an increase in access. At the supra-organizational level, the extent to which territory was concentrated under one organization also mattered, showing how reducing gang boundaries (where control is more explicit) may shape movement patterns. However, I also find institutional heterogeneity, with milícia consolidation being positively associated with visits, while drug gang consolidation reduced access to prenatal care. Taken together, these data provide evidence that policies and practices of organized crime groups have heterogeneous effects, showing how, rather than just a proxy for violence, OC affects access to services and urban dynamics through its governance practices.

Author

• Murilo Enrique Dorion Nieto, Princeton University