Evolution of socioeconomic inequalities in conducting prenatal consultations among Brazilian parturient women: analysis of the period 2000-2015

Mallmann, Mariana Borsa; Boing, Antonio Fernando; Tomasi, Yaná Tamara; Anjos, Juliana Cristine dos; Boing, Alexandra Crispim

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Epidemiologia e Serviços de Saúde

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Brasil

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 27 (4) • 2018 • https://doi.org/10.5123/S1679-49742018000400014 copy

Evolution of socioeconomic inequalities in conducting prenatal consultations among Brazilian parturient women: analysis of the period 2000-2015^* * This study was funded with the support of the National Council for Scientific and Technological Development (CNPq) /Ministry of Science, Technology, Innovation and Communications (MCTIC), through a scholarship granted to Mariana Borsa Mallmann in the context of the Institutional Program of Scientific Initiation Scholarships (PIBIC) 2015/2016, as per Call for Proposals PIBIC/CNPq - PIBIC-Af/CNPq - BIPI/UFSC 2015/2016, dated 8 April 2015.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to analyze evolution as to conducting seven or more prenatal consultations with pregnant women in Brazil, in the period 2000-2015 according to maternal education level and race/skin color of the newborn baby.

Methods:

this was a time series study based on Live Births Information System (SINASC) data; relative and absolute inequalities were investigated, adjusted for maternal age and gestational week in which childbirth occurred.

Results:

we analyzed approximately 48 million births; the proportion of seven or more prenatal consultations increased nationally (from 46.0% to 66.9%) in all groups analyzed; the relative difference between the extremes of education level ranged from 3.0 to 2.0, while the absolute difference ranged from 53.1 to 47.7 percentage points; the adjusted ratio between White/Black race/skin color was 1.4 in 2000 and 1.2 in 2015.

Conclusion:

the proportion of pregnant women having seven or more prenatal consultations has increased in Brazil, although inequalities are still found.

Keywords:
Prenatal Care; Socioeconomic Factors; Educational Status; Ethnicity and Health; Health Status Disparities; Time Series Studies

Sample characteristics				Newborn baby ethnicity/skin color (%)						Maternal education level (in years of schooling) (%)
Year	N	Maternal average age (SD ^a)	Seven or more consultations (%)	White	Black	Asian	Brown	Indigenous	NI^b	0	1-3	4-7	8-11	≥12	NI^b
2000	3,206,761	24.7 (6.3)	46.0	48.6	2.8	0.6	34.6	0.6	12.8	4.4	15.4	38.0	25.7	10.9	5.5
2001	3,115,474	24.7 (6.3)	47.3	47.6	2.6	0.6	36.7	0.6	11.9	4.2	14.9	37.6	27.5	11.2	4.6
2002	3,059,402	24.8 (6.4)	49.1	47.2	2.4	0.5	37.6	0.5	11.8	3.8	15.0	36.3	29.6	11.7	3.7
2003	3,038,251	24.9 (6.3)	51.1	46.1	2.2	0.4	39.6	0.5	11.2	3.3	13.0	36.0	32.2	12.1	3.3
2004	3,026,548	25.0 (6.4)	52.9	46.2	2.1	0.4	40.5	0.5	10.3	2.8	11.7	34.9	34.9	12.9	2.7
2005	3,035,096	25.0 (6.4)	53.6	45.2	2.1	0.3	42.7	0.5	9.2	2.5	10.8	34.0	36.9	13.3	2.5
2006	2,944,928	25.1 (6.4)	55.4	45.3	1.8	0.2	44.8	0.5	7.4	2.1	9.5	32.3	39.4	14.1	2.6
2007	2,891,328	25.2 (6.5)	56.6	44.9	1.7	0.2	46.6	0.5	6.1	1.9	8.4	30.9	41.2	14.7	2.9
2008	2,934,828	25.4 (6.5)	57.7	44.7	1.6	0.2	47.3	0.6	5.5	1.6	7.6	29.6	43.4	15.8	2.1
2009	2,881,581	25.5 (6.5)	58.5	44.6	1.6	0.2	48.1	0.6	5.0	1.4	6.7	28.1	45.2	16.6	2.0
2010	2,861,868	25.7 (6.5)	61.1	44.8	1.5	0.2	48.5	0.6	4.4	1.2	5.9	26.6	47.2	17.7	1.4
2011	2,913,160	25.8 (6.5)	61.8	41.9	3.9	0.3	49.5	0.7	3.8	1.0	5.4	24.7	51.2	15.9	1.8
2012	2,905,789	25.9 (6.6)	62.4	37.5	5.3	0.4	52.1	0.7	4.0	0.8	4.5	22.8	54.4	15.1	2.3
2013	2,904,027	26.0 (6.6)	63.1	36.5	5.4	0.4	52.9	0.8	4.1	0.7	3.8	21.5	55.8	16.2	2.0
2014	2,979,259	26.1 (6.7)	64.7	35.9	5.1	0.4	53.8	0.8	4.0	0.7	3.4	20.6	57.9	17.3	0.1
2015	3,017,668	26.3 (6.7)	66.9	35.5	5.0	0.4	54.0	0.8	4.3	0.6	2.8	18.9	58.7	18.3	0.5

Characteristics	AAPV^a	AAPV^a - 95%CI^b	Interpretation
Maternal education level (in years of schooling)
0	3.2	2.6;3.7	Increase
1-3	3.5	3.2;3.7	Increase
4-7	1.6	1.2;2.0	Increase
8-11	1.2	0.9;1.4	Increase
≥12	0.7	0.5;0.9	Increase
Newborn baby ethnicity/skin color
Black	4.0	3.1;4.9	Increase
Brown	4.2	3.7;4.7	Increase
White	2.4	1.6;3.2	Increase
Asian	5.4	4.1;6.7	Increase
Indigenous (2000-2008)	-5.5	-1.6;-9.2	Reduction
Indigenous (2009-2015)	10.9	10.0;11.7	Increase

Period	Seven or more prenatal consultations, per years of schooling^a
Period	1-3 years	5-7 years	8-11 years	≥12 years
Relative Difference (95%CI ^c) ^b
2000	1.3 (1.3;1.3)	1.9 (1.9;1.9)	2.5 (2.4;2.5)	3.0 (3.0;3.0)
2001	1.4 (1.3;1.4)	1.9 (1.9;1.9)	2.5 (2.4;2.5)	3.0 (3.0;3.1)
2002	1.4 (1.4;1.4)	1.8 (1.8;1.9)	2.3 (2.3;2.4)	2.9 (2.8;2.9)
2003	1.4 (1.3;1.4)	1.8 (1.8;1.8)	2.3 (2.3;2.4)	2.8 (2.8;2.9)
2004	1.3 (1.3;1.4)	1.8 (1.8;1.8)	2.3 (2.2;2.3)	2.7 (2.7;2.7)
2005	1.4 (1.3;1.4)	1.8 (1.8;1.8)	2.3 (2.3;2.4)	2.7 (2.6;2.7)
2006	1.3 (1.3;1.3)	1.6 (1.6;1.7)	2.1 (2.1;2.2)	2.4 (2.4;2.5)
2007	1.3 (1.3;1.4)	1.6 (1.6;1.6)	2.1 (2.0;2.1)	2.4 (2.3;2.4)
2008	1.4 (1.4;1.4)	1.6 (1.6;1.6)	2.1 (2.0;2.1)	2.4 (2.3;2.4)
2009	1.4 (1.4;1.4)	1.6 (1.6;1.7)	2.1 (2.0;2.1)	2.4 (2.3;2.4)
2010	1.4 (1.4;1.5)	1.6 (1.6;1.7)	2.1 (2.0;2.1)	2.3 (2.3;2.4)
2011	1.4 (1.3;1.4)	1.6 (1.5;1.6)	1.9 (1.9;2.0)	2.2 (2.1;2.2)
2012	1.4 (1.3;1.4)	1.6 (1.5;1.6)	1.9 (1.9;2.0)	2.2 (2.1;2.2)
2013	1.4 (1.3;1.4)	1.6 (1.5;1.6)	1.9 (1.9;2.0)	2.2 (2.1;2.2)
2014	1.4 (1.3;1.4)	1.5 (1.5;1.6)	1.8 (1.8;1.9)	2.1 (2.0;2.1)
2015	1.3 (1.3;1.3)	1.5 (1.4;1.5)	1.8 (1.7;1.8)	2.0 (1.9;2.0)
Absolute Difference (95%CI^c)
2000	7.0 (6.5;7.5)	20.4 (19.9;20.9)	34.9 (34.4;35.4)	53.1 (52.6;53.6)
2001	8.0 (7.5;8.6)	20.8 (20.3;21.3)	35.6 (35.1;36.1)	54.5 (54.0;55.0)
2002	9.5 (8.9;10.0)	20.2 (19.6;20.7)	35.0 (34.5;35.5)	54.1 (53.5;54.6)
2003	8.7 (8.1;9.3)	20.6 (20.1;21.2)	35.9 (35.3;36.5)	54.9 (54.3;55.5)
2004	8.6 (8.0;9.3)	20.6 (20.0;21.2)	36.2 (35.6;36.8)	54.6 (54.0;55.2)
2005	8.2 (7.5;8.8)	19.5 (18.8;20.1)	36.1 (35.4;36.7)	53.5 (52.9;54.2)
2006	9.0 (8.2;9.7)	18.4 (17.7;19.1)	35.1 (34.5;35.8)	52.7 (52.0;53.4)
2007	9.7 (8.9;10.4)	18.0 (17.3;18.8)	35.0 (34.3;35.7)	52.1 (51.3;52.8)
2008	11.1 (10.3;11.9)	18.3 (17.5;19.1)	35.2 (34.4;36.0)	52.5 (51.7;53.3)
2009	11.4 (10.5;12.3)	18.5 (17.7;19.4)	35.3 (34.4;36.1)	52.7 (51.8;53.5)
2010	13.5 (12.6;14.5)	19.6 (18.6;20.5)	36.3 (35.4;37.2)	53.0 (52.1;53.9)
2011	13.1 (12.0;14.1)	19.9 (18.9;20.9)	35.6 (34.6;36.5)	53.9 (52.9;54.8)
2012	13.5 (12.4;14.6)	19.7 (18.6;20.8)	34.8 (33.7;35.8)	53.1 (52.0;54.1)
2013	13.6 (12.3;14.8)	19.7 (18.6;20.9)	34.5 (33.4;35.6)	52.7 (51.6;53.8)
2014	14.3 (13.0; 15.5)	19.5 (18.3; 20.6)	33.6 (32.5;34.8)	50.3 (49.1;51.4)
2015	13.3 (11.9; 14.6)	18.6 (17.3; 19.8)	32.4 (31.1;33.6)	47.7 (46.4;49.0)

Period	Seven or more prenatal consultations, by ethnicity/skin color^a
Period	White	Asian	Brown	Indigenous
Relative difference (95%CI^c)^b
2000	1.4 (1.3;1.4)	1.0 (0.9;1.0)	1.0 (0.9;1.0)	0.8 (0.8;0.8)
2001	1.4 (1.4;1.4)	0.9 (0.9;0.9)	0.9 (0.9;1.0)	0.8 (0.7;0.8)
2002	1.4 (1.4;1.4)	1.0 (0.9;1.0)	0.9 (0.9;0.9)	0.8 (0.8;0.8)
2003	1.4 (1.3;1.4)	1.0 (0.9;1.0)	0.9 (0.9;0.9)	0.8 (0.7;0.8)
2004	1.3 (1.3;1.4)	1.0 (0.9;1.0)	0.9 (0.9;0.9)	0.7 (0.7;0.8)
2005	1.3 (1.3;1.3)	1.0 (0.9;1.0)	0.9 (0.8;0.9)	0.6 (0.6;0.6)
2006	1.3 (1.3;1.3)	1.0 (1.0;1.1)	0.9 (0.9;0.9)	0.5 (0.5;0.5)
2007	1.3 (1.3; 1.3)	1.0 (1.0; 1.0)	0.8 (0.8; 0.9)	0.4 (0.4;0.4)
2008	1.3 (1.2;1.3)	1.0 (1.0;1.0)	0.8 (0.8;0.8)	0.4 (0.4;0.4)
2009	1.3 (1.2;1.3)	1.1 (1.1;1.1)	0.9 (0.8;0.9)	0.4 (0.4;0.4)
2010	1.3 (1.2;1.3)	1.1 (1.0;1.1)	0.9 (0.9;0.9)	0.4 (0.4;0.5)
2011	1.3 (1.3;1.3)	1.1 (1.1;1.1)	1.0 (1.0;1.0)	0.6 (0.5;0.6)
2012	1.2 (1.2;1.2)	1.1 (1.1;1.1)	1.0 (1.0;1.0)	0.6 (0.6;0.6)
2013	1.2 (1.2;1.2)	1.1 (1.1;1.1)	1.0 (1.0;1.0)	0.6 (0.6;0.6)
2014	1.2 (1.2;1.2)	1.1 (1.0; 1.1)	1.0 (1.0; 1.0)	0.6 (0.6;0.6)
2015	1.2 (1.2;1.2)	1.1 (1.0;1.1)	1.0 (1.0;1.0)	0.7 (0.6;0.7)
Absolute Difference (95%CI^c)
2000	20.4 (19.8;21.0)	-0.4 (-1.7;0.8)	-0.6 (-1.1;0.0)	-8.4 (-9.8;-7.0)
2001	21.6 (20.8;22.5)	-2.2 (-3.5;-0.9)	-0.8 (-1.4;-0.2)	-10.4 (-11.8;-8.9)
2002	22.2 (21.6;22.8)	-1.4 (-2.8;0.0)	-1.9 (-2.5; -1.3)	-8.7 (-10.1;-7.2)
2003	22.3 (21.7;22.9)	-1.0 (-2.5;0.5)	-3.2 (-3.8;-2.6)	-13.5 (-14.9;-12.0)
2004	22.3 (21.7;22.9)	0.5 (-1.0;2.0)	-5.3 (-5.9;-4.7)	-16.4 (-17.9;-14.9)
2005	22.3 (21.7;22.9)	1.0 (-0.6;2.6)	-6.2 (-6.8;-5.6)	-21.7 (-23.2;-20.2)
2006	22.2 (21.6;22.9)	3.7 (18.4;55.2)	-6.2 (-6.8;-5.5)	-28.6 (-30.2;-26.9)
2007	21.1 (20.5;21.7)	3.6 (1.7;5.6)	-7.6 (-8.3;-7.0)	-33.1 (-34.7;-31.4)
2008	20.4 (19.8;21.0)	2.6 (0.7;4.5)	-8.5 (-9.2;-7.9)	-35.2 (-36.8;-33.6)
2009	20.9 (20.2;21.5)	9.1 (7.4;10.8)	-7.4 (-8.0;-6.8)	-35.1 (-36.7;-33.6)
2010	21.1 (20.5;21.8)	8.6 (6.9;10.4)	-5.7 (-6.4;-5.1)	-35.0 (-36.6;-33.5)
2011	23.6 (23.2;24.0)	11.2 (9.9;12.6)	-0.4 (-0.8;0.0)	-29.1 (-30.4;-27.8)
2012	18.7 (18.4;19.1)	11.9 (10.8;13.0)	-1.6 (-2.0;-1.3)	-32.0 (-33.2;-30.8)
2013	18.4 (18.0;18.7)	10.1 (9.0;11.2)	-1.8 (-2.1;-1.4)	-30.8 (-32.0;-29.6)
2014	16.5 (16.1;16.8)	8.9 (0.77;0.99)	-2.3 (-1.9;-2.6)	-30.6 (-29.4;-31.7)
2015	15.8 (15.5;16.1)	9.4 (0.8;10.5)	-1.5 (-1.4;-1.8)	-28.5 (-27.3;-29.5)

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
E-mail: ress.svs@gmail.com

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[1] Correspondence: Antonio Fernando Boing - Universidade Federal de Santa Catarina, Departamento de Saúde Pública, Campus Universitário, Trindade, Florianópolis, SC, Brazil. Postcode: 88040-970 E-mail: antonio.boing@ufsc.br