The social sciences and humanities on family and kinship: contributions to the Family Health Strategy

Abstract

This article discusses contributions from the social and human sciences on the topic of family and kinship, considering the appropriation of the family as central to public health policies, particularly the Family Health Strategy. Contributions from classical anthropological, sociological, and historical research on the origins, social role, functions, and transformations of the family over time are presented, and include approaches related to family, gender, social class, and other contemporary issues. Specific analyses related to Brazil and the patriarchal family, among other aspects, are discussed along with current demographic data, concluding with comments on the need to expand reflections on the family in the training and guidelines provided to health professionals to strengthen the implementation of public policies.

family; kinship; social sciences and humanities; Family Health Strategy

Resumo

Reflete-se sobre a temática da família e do parentesco, tendo em vista sua apropriação como norte de políticas públicas na saúde, em especial a Estratégia Saúde da Família. São apresentadas contribuições de estudos clássicos de antropologia, sociologia e história sobre origens, papel social, funções e transformações da família ao longo do tempo, incluindo-se abordagens de outras questões contemporâneas. Comentam-se análises específicas sobre o Brasil desde a família patriarcal, apresentando-se dados demográficos atuais e finalizando com comentários sobre a necessidade de ampliar, na formação e nas orientações fornecidas aos profissionais da saúde, reflexões mais amplas sobre família tendo em vista fortalecer a implementação de políticas públicas.

família; parentesco; ciências sociais e humanas; Estratégia Saúde da Família (ESF

In the humanities and social sciences, the study of family and kinship has been renewed and updated over the years. Examined from various perspectives, the idea of family mobilizes scholars and researchers as well as jurists and legislators. More recently, in Brazil the family has become a symbolic battlefield between conservative and liberal ways of thinking that each favor their own definition: one side wants to maintain the hegemonic definition founded on heterosexual normativity, preferably for the purposes of procreation, while the other attempts to incorporate other arrangements including conjugality and family rights for same-sex couples ( Nichnig, 2019 ). In this sense, the 2011 recognition of stable same-sex union by the Brazilian Supreme Court (STF) and subsequent reaffirmation in a 2019 decision ruling District Law 6.160/2018 unconstitutional – this law established a Public Policy to Value Families in the Federal District (Brasília, 2018), and only considered families comprised of a man and a woman – not only represent undeniable advances, but also demonstrate that the notion of family extends beyond semantics to have a concrete impact on access to rights, duties, and citizenship. Being recognized as a family can affect how people are included in (or excluded from) public policies and programs that provide some type of protection or guarantees. This becomes even more relevant when we note that the family has increasingly become the focus of public policies in various areas and sectors such as social security, education, and health. Examples include the Bolsa Família Program, a direct income transfer program for poor families, and the Family Health Strategy (FHS) in healthcare.

Created to expand the population’s access to the health system, the FHS “exhibits an exemplary trajectory” ( Souza, 2010 , p.31) since the program grew from its initial focus (because of scarce resources when it was created) restricted to municipalities facing severe poverty and hunger at that time to become established as a “structuring strategy for a National Basic Healthcare Policy,”¹ and played an essential role in strengthening the Brazilian Unified Health System (Sistema Único de Saúde, SUS) (p.31). Over the years, the FHS has helped reduce infant mortality, increase the number of pregnant women receiving early prenatal care, decrease the number of hospitalizations resulting from conditions such as diarrhea, expand care for individuals with chronic diseases, and establish networks of care in regions of the country that previously did not have access to health services ( Souza, 2010 ).

The FHS is based on the structuring principles of the SUS; in other words, universal access, integrality and equality of care, which is established in Article 198 of the Brazilian Constitution ( Brasil, 1988 ) and ratified in Article 7 of Law 8.080/1990 (Brasil, 20 set. 1990), with its guidelines defined in the National Basic Care Policy (Política Nacional de Atenção Básica, PNAB). More recently, Ordinance 2436 was published in 2017, approving the new PNAB and revising the guidelines that organize this level of care in the SUS (Brasil, 2017). This revision took place during a troubled period in Brazilian politics after the removal of the democratically elected president Dilma Rousseff and the resurgence of discourse from various institutional sectors and all social strata supporting a reduced state role in promoting and financing public policies in areas including health and education. Analysis of the new PNAB reveals that some of the proposed changes could harm the Brazilian population that receives primary health care (PHC), particularly the less wealthy groups that depend entirely on the services provided by the SUS. Though it defined the FHS as “a priority,” the 2017 ordinance permitted other strategies for organizing PHC. This flexibilization is also found in other aspects of the policy that could adversely impact the structure and function of the FHS, for example the ability to differentiate the services offered (“essential” vs. “extended”), as well as a lack of definition on the number of community health agents that should comprise each family health team. Scaling up services may compromise the quality of care offered via PHC in different regions of the country, reinforcing existing inequalities. Meanwhile, the possibility that the number of community health agents per team may be “defined according to population-based, demographic, epidemiological, and socioeconomic criteria, according to local definitions” (Brasil, 2017) could jeopardize the strategic role of this category of workers in strengthening the FHS in the country.

Furthermore, the 2017 PNAB (unlike previous versions) only recommends 100% coverage of the population in socially vulnerable regions or where there is “large-scale territorial dispersion” (Brasil, 2017); although it determines that each basic health and family health team should cover 2,000 to 3,500 people, the document admits that “other coverage arrangements according to vulnerabilities, risks, and community dynamics ... may be greater or less than the recommended parameter according to the specific characteristics of the territory, thus ensuring the quality of care” (Brasil, 2017). In practice, these changes may overload the community health agent and other components of the FHS, negatively affecting population coverage and the quality of health care.

While in principle this flexibility may seem positive, since it is supposed to take different regional realities into account in a country that spans an entire continent, there is also a danger that the advances made possible through the FHS might be lost or weakened. Despite the need for improvement and persistent issues that still need to be considered, the principles of the SUS have been most consistently expressed through PHC. Even today, more than thirty years after the advent of the SUS and the proposal to implement a model based on universal, equitable, and integral access to health care, especially in a historically unequal and unjust country, the system represents an undeniable achievement and a courageous stance on improving the population’s quality of life, especially the most impoverished strata of society. The model of regulated citizenship ( Telles, 2006 ), which was prevalent for so long in the country and ignored the rights of much of the population via criteria related to income, education level, employment, gender, color, and race, was overcome (albeit partially) with the advent of the SUS.

In this sense, the current situation in Brazil marked by the emergence of anti-democratic and notably elitist discourses related to privatization and the market goes beyond empty rhetoric, comprising serious threats to the maintenance of hard-won social rights which still lack consolidation and expansion. While social well-being has never been firmly established in Brazil beyond isolated achievements, the present context is becoming increasingly conducive to the dismantling of rights that previously seemed to have solidly achieved. The advance of a voracious capitalism, led by historically conservative sectors, has found its most predatory expression through the public discourse that government must be ever-smaller to be more efficient. For example, divisions have been created in the federal as well as state governments to promote privatization (Minas Gerais, 2019). This understanding, however, only applies to restricting and/or contingencies for public resources essential to maintaining and expanding public policies, while the benefits to big business from public funding are not diminished (Turtelli, Fernandes, Rodrigues, 18 jun. 2019).

Meanwhile, approval of the proposed reforms to the pension system (which are still under debate) would be highly discouraging for the country’s workers, since raising the bar to access retirement benefits and separating them from a social solidarity function by permitting a capitalization system will increasingly worsen the living and working conditions of the population, who will be forced to work beyond what previously had been considered reasonable age limits (Nuzzi, 17 jun. 2019). The perversity of this proposal is cruelest for rural and field laborers, factory workers, women, and all who work in heavier and more exhausting categories. The scenario becomes even more complex and pessimistic considering the 2016 constitutional amendment to cut spending, which freezes social investments in health and education for the next twenty years (Moretti, 25 set. 2018). For the SUS, the combination of cuts in social rights and poorer living and health conditions for the Brazilian population could lead to even more demands, which will receive even less care if the current panorama continues.

The new PNAB cannot be analyzed outside this context, which could potentially have serious consequences for public health in Brazil, and is especially concerning considering the importance of FHS in strengthening the SUS in the country. From this perspective, it is increasingly necessary to reflect on the structure and principles of the FHS with a view toward collaborating to strengthen it as a structuring focus of PHC in Brazil. The FSH, as indicated by its name, is centered around the health of the family. The PNAB (Brasil, 2017) presents and details the FHS, describing its guidelines, structure, and function. However, it is only in its Annex, “Chapter I: General provisions of basic healthcare,” that the family is described, in less than three lines: “Family, the community, and other forms of collectivity are relevant elements, often conditioning or determining factors in people’s lives and, consequently, in care.” With regard to the Expanded Family Health and Basic Care Center (Núcleo Ampliado de Saúde da Família e Atenção Básica, NASF-AB), formerly known as the Family Health Support Center (Núcleo de Apoio à Saúde da Família, NASF), the text of the PNAB (Brasil, 2017) states that its work process should be established “according to the problems, health demands, and needs of people and social groups in its territories,” without mentioning families or their health needs. Considering the significance of the NASF in supporting FHS teams in terms of an expanded clinic (Fernandes, Souza, Rodrigues, 2019), it is noteworthy that the text of the PNAB (Brasil, 2017) does not emphasize the strategic role of the NASFs. Furthermore, according to Melo et al. (2018 , p.329):

Although in this PNAB there have been no major structural changes in the NASF, attention is drawn to the fact that its responsibility expands to the so-called traditional PC [primary care] teams, removing the term support from its nomenclature, leading to doubts about where matrix-based strategies will have managers responsible for implementing changes, and also putting the FHS itself at risk.

Universal and integral public policies like the FHS constitute an important paradigm shift in a model of Brazilian citizenship, which, as mentioned above, has only through major efforts moved from a reductionist and stigmatizing view that marginalized various categories of society to a concept based on the principles of equality and universality ( Telles, 2006 ). Universal policies are aimed at the entire population, and as such public policies that target the family must address all families. In Brazil, the legal framework defines what is considered a family, and until recently only included the union of a man and a woman and excluded other arrangements such as same-sex unions. As mentioned above, considering recent clashes around the definition of the family according to Brazilian legislation, discussion of the appropriation of the concept of family in public programs and policies is still relevant, since the definitions recognized by law are among the dimensions related to achieving rights and citizenship.

But even if they single out the family as a unit for attention, programs and policies do not always include a deeper discussion of the implications of this definition. In the case of the FHS, the absence of an in-depth discussion on the concept of family can be considered to reflect a common approach in the field of health, which through the influence of the biomedical model often defines family from a strictly biological perspective restricted to aspects related to life cycles, sex, and age group. Despite the emergence of other references and approaches, the biomedical model is still the hegemonic discourse in the field of medicine, constituting a “technical-instrumental reference framework for the biosciences” ( De Marco, 2006 , p.64); one of its characteristics is that it does not consider “the psychosocial context of meanings, which a full and adequate understanding of patients and their diseases depends upon” (p.64). As a result, this concept can lead to a fragmented approach that only includes family health as it relates to the health of its components, linked to sex and/or age: women’s health, the health of pregnant women, children, men, and the elderly, disregarding or minimizing the need to take into account the dynamics and function of various family arrangements. Although the FHS and NASF-AB are based on an expanded clinical approach that considers the context and needs of the subjects, even in developing therapy plans to encourage autonomy and the involvement of the served population, and despite advances made by the FHS to increase access and quality of health care (Macinko, Mendonca, 2018), the lack of a more detailed definition of family in the PNAB (Brasil, 2017) as well as findings from studies and research on the FHS (Fernandes, Souza, Rodrigues, 2019; Peruzo et al., 2018 ; Melo et al., 2018 ; Brito, Mendes, Neto, 2018; Penna et al., 2016 ; Baltor, 2012 ; Dalpiaz, Stedile, 2011; Gabardo et al., 2009 ; Fonseca, 2005 ; Ermel, Fracoli, 2006; Silva et al., 2011 ; Trad, 2010 ; Ribeiro, 2004 ; Alonso, 2003 ) converge to the realization that, from its implementation to the present day, despite the integral nature of the SUS and, in turn, the FHS, it is necessary to emphasize that family encompasses the various formats and arrangements existing in Brazilian society, and guidelines in legislation related to the Strategy about how family health teams should develop actions that are truly focused on families must be strengthened and expanded.

With this in mind, here we reflect on family and kinship through classic and contemporary approaches in the fields of social sciences and the humanities. Considering the central role of the family in guiding public policies, this reflection (which is partly based on the vast literature on this topic) presents and summarizes some of the main trains of thought. These include “classic” authors in the areas of sociology, anthropology, and history (such as Durkheim, Parsons, Lévi-Strauss, Radcliffe-Brown, Malinowski, and Ariès), as well as more contemporary discussions in these disciplines related to topics such as family analysis, gender issues, and social class (including the work of Klaas Woortmann, Strathern, Janet Carsten, Andrée Michel, Segalen, and Singly). Specific reflections on the reality in Brazil are also presented, based on studies by Gilberto Freyre and Oliveira Vianna, who analyzed the role of the family in the formation of the Brazilian nation and culture since colonial times. This analysis includes contributions from research that has focused on the theme of family and power relations in Brazil, revitalizing and updating reflections on political and economic power structures and family origins (Oliveira, 2018).

Considering the current economic and political context in Brazil (categorized by cuts in health funding as well as strong efforts by conservatives to exclude those they consider “inadequate” from public policies, whether these criteria involve race, gender, beliefs, or other factors that do not fit in with the current Christian fundamentalist, heteronormative discourse founded on the values of American imperialism, all expressed in the discourse and positions defended by the current administration), our approach contributes to a reflection on the implications of focusing public policies on the family.

Family and kinship studies: from anthropological approaches to contributions from feminist theories and gender studies

Over time, research in anthropology, sociology, history, and other areas of the social sciences and humanities has developed various approaches that have examined (and still examine) the family and kinship considering concepts/definitions, models, structures, functions, diversity, and/or universality. According to Hita (2005) , initial evolutionary approaches emphasized the idea that different stages of the family have always existed throughout history, and always progress towards evolution or improvement of this institution. Examples include Morgan’s work and its influence on Engels (1984) and his approach to the origin of the family, private property, and the State. After the First World War, the emphasis moved to examining the organization and function of families, focusing on the end of the extended family and consequent transition to the nuclear model and the concept of freely choosing a spouse. These approaches added the nuclear model and affective bias to marriage, as conjugal choice become increasingly based on emotions rather than imposition, as forms of compensation for the end of the patriarchic base and previously extensive character of the family. A third period of family studies in the mid-1950s was characterized in Parsons’ approach, which centered on the inclusion of socialization in reflections on the family, an aspect that previously had been absent (since prior work had focused on conjugality).

Later, with the development of the humanities and social sciences, the scope and approaches to family analysis expanded to include new methodologies and concerns related to gender and sexuality. According to Torres (2010) , William Goode (1969) was responsible for the first Anglo-Saxon studies that recognized women as “full social actors” ( Torres, 2010 , p.91). This perception gained recognition in the 1970s with feminist studies and their contributions to the transition from a concept that only considered women according to biological aspects, particularly reproduction, to an understanding of their role as individuals that was not restricted to limits/possibilities arising from the biological body ( Torres, 2010 ; Hita, 2005 ). Since that time, research has reexamined past themes from new angles including the relationship between families, political and economic power, and political and/or business-oriented trajectories in Brazil ( Oliveira, 2018 ), as seen in the following section.

The origins of the family, the primitive horde, and the incest taboo or: has family always existed?

As mentioned, one main focus in the field of family and kinship studies was the attempt to initially establish how family could be defined and what formats it had taken throughout history by understanding the function and structure of societies. Has the family always existed in the same way, in all societies and during all periods of history? Since it is impossible to precisely determine and reconstruct the early days of humanity, the original suggestion was that at this time there had been a type of primitive horde state with no social organization, including families. Charles Darwin considered this theory, which was appropriated by psychoanalysis to refer to central aspects in understanding the structure and function of the unconscious (Lima, Souza, 2016).

In anthropology, as stated above, the notion of cultural evolutionism was accepted by authors such as Lewis Henry Morgan and inserted by Engels (1984) into his writings on the origin of the family, private property, and the State. Engels proposed an “evolution” of the family over time, according to which the consanguine family was succeeded by the punaluan, pairing, and monogamous families. These stages were differentiated by gradual extension of the incest taboo, which was initially restricted to relations between parents and children. As for family structure, large groups in which the children belonged to the community first prevailed, moving gradually toward the monogamous family composed of a couple (one man and one woman) in which occasional adultery remained a possibility to men, while female infidelity was harshly punished. Among other aspects considered questionable, critiques of this approach mention its foundation on “extremely limited empirical data, which leads to a problematic comparison between contemporary indigenous societies and vanished prehistoric societies, based only on the similarity of cultural knowledge and mechanisms” (Carneiro, 29 maio 2015), as well as the linear view implying “an evolutionism that does not take into account the regressive processes of societies that have declined and disappeared” (Carneiro, 29 maio 2015).

In contrast, Lévi-Strauss (1982 , p.40) considered that the presence of humans always implies the presence of culture in more or less elaborate ways, although he admitted that establishing a starting point at zero and overcoming the primitive horde phase “in the absence of acceptable historical indications, presents a logical value that fully justifies its use”. While in anthropology up to this point there had been a prevailing explanation of kinship in an analogy with biological organisms, as formulated by Radcliffe-Brown (1973) , Lévi-Strauss incorporated the need to study objects structurally, rather than just observing them and making inferences about social structures from their outward appearance.

The incest taboo played an essential role in Lévi-Strauss’s work (1982), where it is made applicable to culture and becomes a part of the culture itself. In addition to its negative prohibition, the incest taboo allowed positive movements that extended the circle to recognize the other. The inability to form a conjugal bond with another member of the family circle leads to the need to look for a partner outside the family, thus opening circuits of exchange in which one family must give its women to another family that needs to do the same. Marriage was based on the formation of alliances and the principle of exogamy. The incest taboo was consequently not related to biological causes (in other words, the fear of congenital defects in the offspring of such forbidden unions), but instead resulted from the need to build alliances beneficial to society, with “the incest prohibition ... the supreme rule of the gift” ( Lévi-Strauss, 1982 , p.481). This notion that the family stems from social rather than biological motives is in contrast with Malinowski’s perception that the family is essentially derived from the biological and psychological impulses of individuals (Malinowski, 1983).

Broadly speaking, various authors in the social sciences attribute a decisive role to the incest taboo, understanding that it makes culture possible and effective. For example, both Lévi-Strauss and Malinowski recognized the role of this taboo in culture; Lévi-Strauss saw this prohibition as essentially positive, moving from the hermetic nature of the restricted family to the broader scope made possible by gift exchange and reciprocity. Malinowski (1983) did not disregard the question of alliances established as a result of the incest taboo, but emphasized its disorganizing potential for the family structure and, in turn, for the socialization that families should provide their younger members. Woortmann (2002 , p.15) states, on Malinowski’s thinking: “If incest is a universal temptation, it needs to be prohibited because ... if it were permitted, the fundamental relationship between children and their parents would be destroyed.”

Malinowski’s approach to family and kinship, built from his experience with the peoples of the Pacific, is characterized (among other aspects) by the strong influence of psychology and consequent perception of individuals’ choices as the driving forces of societies, even where there is at least theoretically little room for these choices. Marriage and the family make it possible to accommodate and preserve feelings associated with the initial state of passion and sexual interest between individuals. Marriage celebrates a contract between two individuals, which does not impede each new union from being associated with new social movements by constructing reciprocal circuits between the families involved.

Understanding the smallest unit of kinship systems: elementary or nuclear family and the atom of kinship in Lévi-Strauss

Analyses of the origins of the family gradually turned to an attempt to identify its smallest unit in kinship systems. In general, the responses focused on identifying the nuclear and/or elementary family as this initial unit (from including De Coulanges, 1961 ; Radcliffe-Brown, 1973 ; Malinowski, 1983 ), Lévi-Strauss’s “atom of kinship” (Lévi-Strauss, 1973, p.84), the identification in some societies of family roles and functions but the absence of the nuclear or elementary family as the smallest unit of kinship, with other organizational structures typical of matrilineal societies pre-dating the family (Fox cited in Woortmann, Woortmann, 2004), as well as the fact that the smallest family structure in some societies would be a mother and her son(s) (Adams, cited in Woortmann, 2003 ).

For Malinowski (1983) , the nuclear family was expanded through successive unions. The foundation of kinship is exogamy, which extended sexual taboos within the individual family. Meanwhile in Lévi-Strauss, the elementary structures of kinship consisted of blood ties, alliance relations, and parentage relations (Lévi-Strauss, 1982; Woortmann, 2003 ; Sarti, 10 dez. 2009). The smallest unit in this system or “atom of kinship” was directly related to the incest taboo and involved relationships at four different levels: husband/wife, father/son, brother/sister, and maternal uncle/nephew. The existence of this fundamental unit is based on a system of exchanges between two groups: one that provides a woman and the other that receives her. In this sense, this system introduces a figure whose role had not been previously recognized in the kinship system: the mother’s brother, who relinquishes his sister to allow her to marry a man from outside the family. According to Sarti (10 dez. 2009; emphasis in the original): “In this way, Lévi-Strauss ... introduces the notion that the mother’s brother is not an ‘extrinsic element,’ but ‘an immediate datum of the simplest family structure.’” Beyond the superficial appearances of social structures and facts, at the end of the day “the rules of marriage are various ways of guaranteeing the circulation of women, in other words, replacing a system of biologically-based blood ties with a system of alliances” (Lévi-Strauss, 1973, p.76).

Unlike Radcliffe-Brown, Lévi-Strauss did not consider the family to be the origin of societies or kinship, but instead the exchange made possible by the incest taboo, since society could only exist in opposition to the family, allowing its duration for a limited period. The advantage of exogamy would be to allow social cohesion by overcoming the self-sufficient status of the consanguineous family, thus shifting from the sphere of nature (embodied in blood ties) to the sphere of culture through alliance. To Lévi-Strauss, it is the sexual division of labor that makes marriage necessary, by making the sexes interdependent upon each other.

In Radcliffe-Brown (1973) , as mentioned, the nuclear family is the smallest unit in the kinship and affinity system, and reproduction is the essential purpose of its existence. In this sense, couples without children could not truly be considered families. The system of kinship and affinity based on the elemental family branches into different levels that are differentiated by the types of relationships between their components and the blood or affinity ties that exist between them. Through successive unions between members of distinct elemental families, genealogical relations expand continuously. In this way, Brown examined the kinship system via person-to-person relationships, forming an individualistic perception of kinship.

Next, the analysis by the French historian De Coulanges (1961) , originally published in 1864, extensively investigated social institutions, including the family. This author compared the customs, culture, and structures of societies since antiquity, noting that in Greece and Rome family as an institution was constituted by religion, which also instituted marriage and paternal authority, thus determining lines of kinship based on the right to ownership and transmission through inheritance. According to De Coulanges, social structure was relatively undeveloped in antiquity, and families were essentially self-sufficient and related to each other by descent, organizing themselves into extensive networks of relationships that worshipped the same gods together and recognized each other through reciprocal duties and rights. Called gens , this extended family was considered to influence the function of Greek and Roman societies for several centuries until they weakened due to eroded links between their components stemming from structural changes in the societies over time, particularly the emergence of cities (Silva, s.d.). The centrality of religion in the organization and function of these societies implied a strong intermingling between the dead and living that was reflected in families, also based on the duty to procreate and continue the family lineage. This was the justification for levirate marriage, where widows or wives of infertile men were allowed to marry their brothers-in-law, and the resulting children were considered the offspring of the first husband.

Functionalist approaches to family: Durkheim and Parsons

Over time, studies have shifted their focus from efforts to define family and kinship to attempts to understand their functions. In this sense, the functionalist train of thought yielded important reflections, for example Durkheim’s work showing the transition from the paternal and/or the patriarchal family to the modern conjugal family, and also valuing the individual’s role in relation to the family collective, while highlighting the role of greater state intervention within the context of this family arrangement (Durkheim, 1975a, 1975b). Among other aspects, Durkheim considered that the modern family was founded upon marriage, and despite the persistence at some level of family influence over the choice of spouse, strengthening children’s autonomy from their parents would increasingly lead to a free choice of partner. His perception that over time, the institute of inheritance would no longer play a central role in the transmission of possessions and capital did not materialize, and quite to the contrary is still a function of the family in contemporary capitalist societies and strongly related to persistent social inequalities, as pointed out by Bourdieu (1974 , 1975 , 2003 ), who considers the family to be the locus of transmission and reproduction of various types of socially valued capital (cultural, social, and economic, for example).

Meanwhile, in a review of Freudian concepts and approach to Durkheim, Parsons (1966 ; Parsons, Bales, 1955) considered that human activities follow structural rules and models which are internalized by children during development. It is within this scope of an evolutionary functionalism that Parsons analyzed the family. Considering the industrial stage of modern societies as the most advanced form of social organization possible, Parsons also considered the nuclear family (notably the American model) as the standard, and other formats and arrangements distant from this “ideal.” He analyzed the typical 1950s “white, Anglo-Saxon, Protestant” family that incarnated all the social values demonstrating the superiority of the American culture and nation, because of its capitalist “progress” and the ideals of democracy and meritocracy. As part of Parsons’ formulation on a general theory of action, his theory of personality and socialization can be divided into four phases according to psychoanalytic theory: first, a baby’s complete dependence upon her mother, followed by a phase of loving emotion and differentiation between the parents and the self, Oedipus crisis and a state of latency in the third stage, ending with maturity. With a focus on what he called the third phase of developing socialization and personality, Parsons believed that processes of socialization gradually confer autonomy on children, making them less dependent on their mothers, with the child gradually progressing from a mother-centered system of solidarity to a family-centered one.

Critiques of Parson’s approach and its appropriation of psychoanalytic theory highlight the superficial nature of this appropriation; only the roles of the parents within the family are considered in an exhaustive exploration of the processes and content related to libido and instinct in personality development. Socialization is summarized in the understanding that girls learn to be women by imitating their mothers, and boys learn to be men by imitating their fathers. The family, according to Parsons, essentially has two functions: to socialize the children and to stabilize the personality of the adults, which takes place through sexual roles, mechanisms through which people are integrated into systems of activities. Four roles are involved, constructed from two axes of differentiation, one axis of power (which differentiates the roles of parents and children), and an instrumental/expressive axis that refers to the differences between men and women, with men fulfilling instrumental roles and women expressive ones. Critiques of Parsons indicate the importance of including socialization among the functions of the family, and (among other aspects) question the pathologization of other family models ( Hita, 2005 ; Torres, 2010 ) and the rigid division of roles exercised by men and women: “by failing to differentiate and separate sex from gender, ultimately the Parsonians to a certain extent emphasized relationships that in theory were not conceived as such in this model” ( Hita, 2005 , p.127-128).

Family and gender: feminist studies

The advent of feminist studies began to question dominant approaches in the field of family studies, which assigned women the role of submission to men and the exclusively domestic function of raising children. These studies denatured concepts of gender and sex, showing their historical and social character ( Strathern, 2017 ; Michel, 1983 ). They initially focused more narrowly on identifying inequalities between men and women, and made it possible to name phenomena such as male oppression and domination ( Torres, 2010 ; Hita, 2005 ). In French sociology, studies by Andrée Michel (1983) helped develop criticism of Parsons’ approach by revealing the productive dimension of domestic work (in other words, its economic and exchange value) and pointing out many positive aspects of expressive and instrumental roles played by both men and women. The growing presence of women in the labor market, analyzed according to its positive aspects, showed that gains in economic terms as well as in self-esteem for women also benefit their families, and these gains are catalyzed when an effective maternity support network is established through public policies. Meanwhile, the difficulty of reconciling careers, motherhood, and domestic work was highlighted among the not-so-positive aspects of this situation. In countries such as Brazil, where a state of social well-being has not been established, this is an especially difficult factor for women entering the job market, particularly those from lower classes who managed (and still continue to manage today) two full-time jobs in their daily lives with little to no public support (Verdélio, 6 mar. 2017).

The question of gender, especially related to women and motherhood, which for so long was romanticized and idealized as the apex and overarching objective of female existence, was also questioned by studies starting in the 1960s and 1970s that found a drop in women’s perception of their marital happiness after the birth of their children; this was also seen in families where only the woman performed domestic tasks ( Michel, 1983 ). The sexual division of labor, which prior to feminist studies had only been approached from its positive bias, was now considered in light of its subjective effects within the family environment, especially women’s unhappiness.

Among Brazilian studies, one of the first proponents of the correlation between gender and family was Klaas Woortmann (1987 ; Woortmann, Woortmann, 2004). In his work on family and kinship themes, Woortmann surveyed poor families in Salvador, Bahia and identified a strong matrilineal component in these groups. His influences included Leach and Bourdieu, and he also conducted ethnographic studies on Brazilian peasants (Schwade, Woortmann, 16 mar. 2015; Woortmann, 1990 ) that referred to Pierre Bourdieu to understand and identify a matrimonial market functioning among these groups. This market involved strategies demonstrating that conjugal choices add a non-random component, since marriages were seen to follow a preferential pattern favoring unions that strengthened existing kinship relationships and helped maintain a strong relationship with the land in these communities.

Specific focuses on LGBT families have also broadened these themes and their approaches. In the case of Brazil, developments in this area have intensified alongside demands and social movements to ensure rights for families comprising gay, lesbian, bisexual, and transgender people ( Nichnig; 2019 ; Grossi, 2003 ). Full citizenship and recognition of these family models as legitimate are rooted in a broader principle of recognizing identities and individualities (among other issues), in the sense proposed by Stuart Hall. A Brazilian landmark in this area was the 2011 ruling by the STF that “continuous, public, and lasting union between two people of the same sex is considered a stable union, as a family entity, as determined in Article 226 of the Constitution and Article 1273 of the Brazilian Civil Code” ( Nichnig, 2019 , p.162). Meanwhile, registration of these marriages in public halls of records was only determined in 2013 through a resolution by the National Justice Council.

Commenting on the evolution of Brazilian legislation related to family and conjugality, Nichnig states that only after the 1988 Federal Constitution were heterosexual couples who did not formalize their unions via civil registration recognized as families. However, this significant step toward legally expanding the concept of family did not include same-sex families. In 2002, the new Brazilian Civil Code (Brasil, 2002) specified that the possibility of recognizing stable union addressed couples composed of a man and a woman. In this way, the fact that Brazilian legislation until recently did not include same-sex couples and families reinforces (in the 2011 STF decision) “a strong symbolic effect, as it produces recognition and consequently produces rights for couples. If these couples [previously] did not have legal equality in relation to heterosexual couples, the STF decision will fill this legislative gap, even if this non-affirmation of rights leads to legal uncertainties” ( Nichnig, 2019 , p.164). Comparing the political and institutional context experienced in 2011 Brazil with the current situation, Nichnig describes that time as more conducive to discussions of gender and sexuality, unlike the current rejection of this approach by conservative sectors, who label it “gender ideology.” This reinforces the need to remain vigilant with regard to social achievements in recent years, so legal recognition of same-sex families and other rights will not face setbacks, such as the aforementioned 2018 law in Brasília that attempted to define family as only heterosexual in matters related to public policies.

Other family and kinship approaches

Besides the gender-related contemporary approaches to family and kinship (as mentioned earlier) analyzed from the bias of feminist studies and same-sex families, and more recently, considering the concepts of masculinity and parenting (Nogueira, Miranda, 2017; Wall, Aboim, Cunha, 2010), studies have also examined topics such as the relationship between social class and family belonging ( Fonseca, 2005 ), the impact of reproductive technologies on the understanding of family ( Carsten, 2014 ), family, identities, and individualization ( Segalen, 2013 ; Rocha et al., 2001 ; Singly, 2007 , 2000 ), as well as analyses of material and non-material dimensions of kinship such as bodily substances, blood and other fluids, aspects which are less tangible but still carry a very significant symbolic weight, a topic that is not exactly new, but has been revisited and examined more deeply in recent years ( Carsten, 2014 ). By embracing the concept of the “mutuality of being” developed by Marshall Sahlins (according to which, in various societies and in various historical periods, relatives participate in each other’s lives in what constitutes a type of shared existence), Carsten reflects on “the material of kinship,” more specifically blood. Like other recent studies in anthropology, this perspective values the understanding of the various ways in which kinship is reinvented: “appearing in different guises with different effects: food, houses, land, procreation, memory, emotion and experience – to mention just a few – can be effortlessly encompassed by the idea of ‘mutuality of being’” (Carsten, 2014, p.105; emphasis in the original).

While anthropology originally was devoted to defining what is and what is not kinship, more recently the focus has been on “the ways that kinship accumulates or dissolves over time – processes of ‘thickening’ or ‘thinning’ of relatedness” ( Carsten, 2014 , p.106; emphasis in the original). Biology and medicine have proven that blood and other genetic materials carry attributes specific to each family that can be used to prove paternity, as in DNA testing. Along with other social, cultural, and biological constructs, the symbolic character of blood defines the limits that separate “us” and them. Along the same lines as reflection on substances and kinship, Carsten points out the immaterial qualities of substances such as photographs, letters, and documents as being able to evoke other dimensions of kinship beyond the present moment, relating other spaces and events that build and are themselves also part of kinship.

Segalen, in an interview with Rocha et al. (2001) on trends in family and kinship research in recent decades, commented on how social changes such as greater urbanization have led to challenges for ethnographic research involving the family, since “prior to the 1960s, the question of kinship, work, transmission, succession, all of this, had evidence and exteriority. Today, everything is shown in a more disjointed, less transparent way,” ( Rocha et al., 2001 , p.282) and remarked on the difficulty of ethnography on “kinship, in the urban environment. What to observe? Where to start?” she asked (p.282). Although rituals associated with kinship remain in the contemporary world, researchers must be cautious and flexible in order to access the family. Segalen emphasized the interdisciplinary nature that the topic of family and kinship has been acquiring, in view of the interests and issues that gravitate around themes such as reproductive medicine that add new aspects related to this theme. The topic of identity, correlated with family identity, geographic origin, and cultural and geographical displacements, for a time was central to Segalen’s studies, an importance that later shifted to other approaches such as the various roles attributed to grandparents in different cultures around the world, and the correlation between kinship and social classes (Segalen, 2013; Rocha et al., 2001 ).

Francois Singly (2000 , 2007 ), in turn, analyzed the relationship between the birth of the individualized individual and subsequent effects on marital and family life. Examining contemporary families in Europe, particularly in France, Singly pointed out that since the mid-1960s there has been a fundamental change in the conception of the individual in terms of their identification with their groups of origin and belonging. This individualized individual, whose true identity is only possible through contact and relations with others, is characterized by a quest for autonomy and has a notable position at the heart of private relations that include family and conjugality. Thus:

In individualistic societies, ‘the family’ (in whatever form or structure) assumes for itself the function of (trying) to permanently solidify the ‘I’ of adults and children. ... Consequently, the family has changed to produce these individuals. ... Schematically, the period of the late 1960s, which we still experience, corresponds to the establishment of a commitment between the demands of individuals to become autonomous and their desires to continue living in the private sphere with one or more people nearby. It is the family I call ‘individualist and relational’ ( Singly, 2000 , p.15; emphasis in the original).

Most of the studies mentioned above have focused on the realities and contexts of other countries and their cultures. In Brazil, with the establishment of the social sciences and humanities, the topic of family was soon addressed through analyses based on formation of the nation’s identity, history, and culture. Over time, this approach included other angles of analysis, as described in the following section.

The Brazilian family

Studies on family and kinship in Brazil inevitably refer to the classic works by Gilberto Freyre, Sérgio Buarque de Holanda, Oliveira Vianna, and other authors who examined the Brazilian Constitution and pointed out the fundamental role played by a certain type of family in the past and still today, to a certain extent, in constructing a Brazilian habitus: the Brazilian patriarchal family. In Freyre’s work the family is prominent and considered the country’s colonizing unit, with a more relevant role than other institutions. During the colonial period, the patriarchal family was characterized not only by the dominant male figure, but also self-sufficiency, built around a diversified structure in terms of resources and potential: the big house, slave quarters, crops, livestock production, sometimes also a small school, a chapel etc. While the family was closed off, it was simultaneously connected to its surroundings by providing services that the government did not offer, since at that time its presence was diffuse and incipient (Freyre, 1999). The Brazilian patriarchal family was established within a slave-based, landowning system founded on single-crop farming. Known for defining a Brazilian racial democracy, Freyre’s thinking identified a central role for the patriarchal family in defining Brazilian identity, derived from the meeting of peoples from Portugal and Africa and Brazil’s indigenous groups. From the relations between European white men and African and indigenous women (consensual as well as forced) came a type of extended family resolving around the “official” family of the white man and his white wife. The vision of this family as central to the constitution of national identity can be seen throughout Freyre’s work, even in his examination of changes in social structure, the economy, architecture, and city organization ( Alves, 2018 ).

Meanwhile, Sérgio Buarque de Holanda (1995) highlighted the influence of Portuguese cultural values in shaping national identity, following the example of the culture of personalism, which emphasizes aspects derived from charisma and individual merit, to the detriment of collective values. To Holanda, the state played a central role in organizing Brazilian society, acting on the basis of personalist and authoritarian character ( Alves, 2018 ). As in Freyre, the patriarchal family was the organizing locus of life in colonial rural Brazil, and focused on the authority of the white male landowner. One contribution from Holanda’s approach is the observation that the spirit of this arrangement continues to influence Brazilian society, even after the end of the patriarchal family ( Oliveira, 2018 ; Itaboraí, 2005 ). Marks of this influence can still be seen in the influence of family origin even today, with surname considered more important than individual achievements.

Similarly, Oliveira Vianna (1987) highlights how the influence of the patriarchal family in Brazil and its organization into structures he calls “clans” constituted a unique culture based on relationships of obligation and subservience between those who were not included in the main sphere of the clans and the families who dominated these forms of organization. According to Vianna, Brazil did not in fact become a democratic nation, but is one in name only since powerful clans dominate institutions at all levels (Vianna, 1987; Oliveira, 2018 ).

The correlation between family and political power as a contemporary phenomenon (rather than one restricted to Brazil’s colonial origins and the Empire and First Republic periods) is the backdrop for the text edited by Oliveira (2018) ; this work consequently differs from studies produced between 1950 and 1990 that mostly viewed strong family connections to political structures as typical of poorer, “backward” regions of the country. In order to analyze the factors through which “family imports and explains,” some comments are presented on the strong and ancient historical roots of some of the main families that dominate Brazil’s political power structures. Beyond a review of the Brazilian political scenario, these authors show how the same families have shared control of the country since its discovery. For example, Francisco Antonio Doria examines the genealogy of his relative João Doria, the current governor of São Paulo state and a descendant of Fernão Vaz da Costa, Lodisio Centurione Scotto (the banker who financed the Columbus expedition), and other important historical figures. In this exemplary analysis, Doria scrutinizes how his ancestors moved over the space of a few generations from low-level bureaucrats to ministers and power-wielding figures. The answer is that power was achieved through alliances and networks of relationships, more specifically through marriage. Even today, power is maintained by the frequent search for associations with equally or more powerful families, from generation to generation. The relationship between family, origin, surname, and political power in Brazil is so strong that “about one-third of Brazilian presidents are descended from the couple Braz Teves and Leonor Leme, a couple who lived in São Vicente around 1600; if they are not descendants, their families attended the Teves-Leme wedding” ( Doria, 2018 , p.7). Machado (2018) , in an introduction to the book edited by Oliveira (2018) , mentions the impeachment of President Dilma Rousseff, emphasizing that even without proof that she committed a crime, most of the 367 lawmakers who voted for impeachment justified their action as a “vote for the family.” Considering the platforms defended by the parties these politicians were affiliated with at that time, we must ask which family they were referring to, since they defended the notion of economic liberalism, downsizing the government, and restricting social policies.

So even with all the social, cultural, and economic changes Brazil has undergone over the past several hundred years, the culture of using the state to benefit certain social groups is still notable, and according to Oliveira (2018) represents the interests of a political and business elite that has relinquished a collective nation-building project to advance only its own interests. Although the classic model of the patriarchal family (rural, slaveholding, organized around the big house and the slave quarters) no longer exists, the structuring spirit of this family continues to influence relations between the social classes and Brazil’s institutional makeup. The traditional Brazilian family is defended with a certain nostalgia, but what is really being protected is the ownership of the country’s power structures by the elites. Although this patriarchal model was just one of several existing in the country since its origins, its strength as an organizing hegemonic vector shaped Brazilian practices and institutions. But despite its strength as an institutional model for practices, the patriarchal family has existed alongside various other kinds of families since the early colonization of Brazil.

Studies examining documents, wills, and reports from foreign travelers allow us to see that, although they were not officially recognized, in this majority-Catholic country there have always been families formed through concubinage, unofficial unions, relations between slaves and landowners, as well as single-parent families: “the colonial family assumed so many shapes, with recent historiography exploring its origins and the character of unions in detail, emphasizing the multiplicity and specificities as a function of the regional characteristics of colonization and the social stratification of individuals” ( Algranti, 1997 , p.87). Considering the current context, data from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística, IBGE) indicate growth in more diverse formats; changes in family arrangements extend beyond novelty, and rather speak of the search for social legitimation of models and structures that often already exist. The understanding that non-hegemonic family arrangements are not exclusively modern helps dismantle prejudices and preconceived notions that attribute the existence of single-parent or same-sex families to “social degradation” ( Neto, 2017 ; Penna et al., 2016 ).

Not only is the diversification of family arrangements not a novelty or exclusively modern, it has been an expanding process. In recent centuries, societies have undergone profound transformations, and especially since the twentieth century, changes related to social, economic, and behavioral factors have contributed to changes in family composition and dynamics ( Trad, 2010 ). The demographic census carried out by IBGE (2010) collected information about Brazilian families and considered various arrangements beyond the nuclear family comprised of a heterosexual couple with children. Data from this census indicated more people were living alone in “single-person households,” about 6.9 million or 12.1% of the 57 million visited households. In 400,000 households, the residents did not have kinship ties, which was also an increase over the 2000 census. Growth in the percentage of married couples without children was also seen, a one-percentage point increase in single-parent families headed by women (higher in urban areas than in rural areas), as well as more households in which women were the family provider.

More recently, in 2015, the National Household Sampling Survey (Pesquisa Nacional por Amostragem de Domicílios, PNAD) corroborated the census findings ( IBGE, 2016 ). Historical PNAD data show that as of 2005, the nuclear family (father, mother, and children) ceased to be the predominant model in Brazilian households. Comparison of PNAD data for 2015 and 2005 shows a decline of 7.8 percentage points for nuclear families during this period, dropping from 50.1% to 42.3% of the arrangements found in Brazilian homes ( Neto, 2017 ). Factors such as the greater presence of women in the labor market in various roles and sectors, driven by a greater presence of women in schools, at all branches and levels of the education system, as well as the legalization of divorce, dissemination of contraceptive methods, and advances in reproductive medicine have led to new possibilities for maternity and paternity (Haag, fev. 2012; Priore, Bassanezi, 1997).

Additionally, the sociability and function of families have evolved significantly over the years, partly due to changes in how children, adolescents, and the elderly are defined, and consequently the roles and positions these figures occupy in the family structure. For example, the notion of childhood has changed over time and still varies today according to different groups and societies. In Europe, whose habits and models helped shape Brazilian society, for several centuries children were considered “small adults,” and did not receive differentiated care and/or attention ( Ariès, 1981 ). In early twentieth-century Brazil it was common for 8-year-olds,² particularly from poorer and more vulnerable families with fewer financial resources, to work long days in factories ( Grunspun, 2000 , p.52). It was a long road to move beyond the notion that children are simply miniature adults requiring differentiated care, and without this special treatment will suffer high rates of mortality and physical and mental illness. This understanding was developed based on theories and discoveries from fields including health, psychology, child care, and pedagogy ( Ariès, 1981 ; Priore, 1999 ; Freitas, 2016 ). Children evolved from “raunchy monkeys” ( Ariès, 1981 , p.10) to the “subject of fundamental rights inherent to human beings,” as stipulated in Brazil by Article 3 of Law 8.069 of July 13, 1990, which establishes the Statute of the Child and the Adolescent (Brasil, 16 jul. 1990).

The rebound effect of this concept also generated a new function for the family, which was now responsible for nurturing, safeguarding, and educating individuals legally considered children and adolescents. These changes, among other factors, led to (and are the product of) profound social changes, which have resulted in alterations in family dynamics and composition. For this reason, reflections on contemporary families must consider social, cultural, and behavioral modifications recorded in recent years, as well as their impacts on family function. Still, observation of the alterations mentioned herein and their impacts on family arrangements, function, and dynamics cannot obscure the understanding that diverse family models significantly predate changes in Brazilian society over recent centuries. Furthermore, according to Fonseca (2005) , an important perspective for family and kinship studies is to understand how families experience these connections, and in turn, how professionals who interact with them can build possibilities for intervention without being tied to idealized notions of family and its functions.

Final considerations

This article presented some of the main approaches from studies and research on family and kinship constructed through the humanities and social sciences, a field which is difficult to summarize due to its breadth and depth but extremely rich. Still, we hope it will contribute to an overview of these studies and their main themes. In addition to a conceptual field (as mentioned in the introduction), the family also represents a battlefield, considering its potential in structuring the formulation and implementation of public policies. Although the focus in research has long since shifted away from attempts to define the family, this clash is still present in the field on a day-to-day basis. At historic moments, such as modern-day Brazil marked by more intense conservative ideologies, the family is fertile ground for intense disputes that have even been translated into legal provisions such as the Constitution, the Civil Code, and the Family Statute (which is currently in the Chamber of Deputies for consideration), and has even been used to justify the exclusion and/or inclusion of certain content in school curricula. Under the banner of the “family, propriety, and tradition,” a restricted and pathologizing concept of other family models has been defended in Brazil. If we are not vigilant, these movements and concepts may lead to losses in all social and institutional levels and spheres, including the SUS. This internationally-recognized public policy has inspired various countries, but the SUS is not safe from recent setbacks as predatory neoliberalism grows, along with its capacity to disarticulate and deconstruct advances in social policies. We must consequently be careful to maintain and defend the undeniability of the principles that the SUS was founded upon: universality, equity, and integrality. On the contrary, movements must consolidate and strengthen the undeniable gains provided by the SUS, especially the FHS and its work in structuring PHC.

In this way, to prevent the dismantling and weakening of the FHS as an articulating principle of basic care and consequently avoid any potential negative effects of the new PNAB (Brasil, 2017), strict vigilance is required. There are possible strategies, some already posited in research examining the performance of health professionals in the FHS: strengthening the training of health professionals at all levels of training and including permanent education, access to reflections on the family, its functions, and functional dynamics, as well as providing professionals with strategies to approach, intervene in, and follow families to construct increasingly qualified health care. In the current political context, the NASF must also be bolstered in terms of its role in supporting family health teams, considering expanded health care, and to prevent overload and burnout among the community health agents who play an essential role in the FHS. In short, other structural models of PHC established in current legislation must be stopped from weakening the role of the FHS in further solidifying the SUS in Brazil. These are arduous tasks, but they are essential if public health in our country is to remain the right of all and the duty of the State, and if the notion that all families have rights and can be part of constructing health care is to advance.

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NOTES

• Translated by Tracy Miyake.
• 1
  In this and other citations of texts from Portuguese, a free translation has been provided.
• 2
  Unfortunately, despite advances in social and human rights, child labor is still a blot on the face of Brazilian society. According to IBGE data for 2013, “the number of young workers corresponds to 5% of the population between 5 and 17 years old in Brazil” (Brito, 12 jun. 2017).

Publication Dates

• Publication in this collection
  28 June 2021
• Date of issue
  Apr-Jun 2021

History

• Received
  25 Feb 2019
• Accepted
  16 Jan 2020