Inequalities on coverage of prenatal assistance in Brazil: a nationwide study

Flores, Thaynã Ramos; Neves, Rosália Garcia; Mielke, Grégore Iven; Bertoldi, Andréa Dâmaso; Nunes, Bruno Pereira

doi:10.1590/1413-81232021262.26792019

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ARTIGO • Ciênc. Saúde Colet. 26 (02) • Feb 2021 • https://doi.org/10.1590/1413-81232021262.26792019 copy

Inequalities on coverage of prenatal assistance in Brazil: a nationwide study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This article aims to evaluate the coverage and inequalities in prenatal assistance. Data from the Brazilian National Health Survey cross-sectional study in 2013. Prenatal assistance assessed through indicators: counseling, guidance received, procedures, and exams performed during the pregnancy. An asset index constructed, the Slope Index of Inequality (SII) and Concentration Index (CIX) were used to measure. About 90% received counseling on healthy eating, not smoking and drinking, 80% not to use dye/hair straightening, and all the advice. Approximately 70% received guidance on delivery and signs of risk and 83.4% for breastfeeding and 60% all the guidelines. About 80% had the measure of pressure and weight checked, the measure of the abdomen and the auscultation of the heart of the baby, only 36.7% had their breasts examined e 33.4% all procedures performed. More than 90% held for HIV and urine and 77.9% for syphilis, 81.4% of women have carried out all the exams and 21.7% all the indicators. No significant absolute differences (SII) found. CIX evidenced in counseling for healthy eating and guidance for breastfeeding. There were no marked inequalities in prenatal assistance.

Key words:
Maternal Health; Healthcare Disparities; Quality Indicators; Brazil; Cross-Sectional Studies

Variables	N (%)	CI95%
Skin color*
White	733 (40.3)	38.0; 42.5
Black	162 (8.9)	7.6; 10.2
Brown	925 (50.8)	48.5; 53.1
Marital Status
Married/with companion	592 (33.1)	30.9; 35.3
Separated or divorced	86 (4.9)	3.8; 5.8
Widow	68 (4.8)	2.9; 4.7
Single	1.042 (58.2)	56.0; 60.6
Education level
No education	5 (0.4)	0.004; 0.7
Elementary School	357 (26.6)	24.3; 29.0
High school	732 (54.6)	51.9; 57.3
Higher education	247 (18.4)	16.3; 20.5
Asset index
1^st quintile (poorer)	263 (14.2)	12.6; 15.8
2^st quintile	391 (21.1)	19.3; 23.0
3^st quintile	349 (18.9)	17.1; 20.6
4^st quintile	418 (22.6)	20.7; 24.5
5^st quintile (richest)	430 (23.2)	21.3; 25.2
Number of prenatal consultations
0 - 6 consults	625 (33.8)	31.6; 35.9
7 or + consults	1,226 (66.2)	64.1; 68.4

Indicators of prenatal assistance	Slope Index of Inequality (%)	CI95%	Concentration Index	CI95%
All counselling	0.02	-0.64; 0.68	- 0.001	-0.015; 0.013
Counselling for healthy eating	0.23	-0.02; 0.5	0.022	0.007; 0.009
Counselling for not smoking	0.38	-0.06; 0.82	0.005	-0.003; 0.013
Counselling for not drinking	0.28	-0.15; 0.70	0.005	-0.002; 0.013
Counselling for no use of dye/hair straightening	0.13	-0.50; 0.76	0.002	-0.010; 0.015
All guidance	2.93	-0.48; 11.7	0.008	-0.011; 0.028
Guidance on delivery	0.36	-0.37; 11.0	0.008	-0.009; 0.025
Guidance on signs of pregnancy	0.41	-0.28; 11.0	0.007	-0.008; 0.022
Guidance on breastfeeding	0.66	0.06; 12.6	0.013	0.002; 0.025
All procedures	3.8	-0.39; 11.4	0.011	-0.026; 0.048
Blood pressure measurement	0.34	-0.15; 0.83	0.006	-0.003; 0.015
Weight measurement	-0.006	-0.49; 0.47	0.0004	-0.008; 0.009
Abdomen measurement	0.16	-0.47; 0.78	0.005	-0.008; 0.018
Baby heart auscultation	0.12	-0.54; 0.78	0.002	-0.012; 0.016
Breast exam	0.45	-0.32; 12.3	0.024	-0.011; 0.058
All exams	4.49	-0.24; 11.4	0.009	-0.004; 0.023
Syphilis examination	0.42	-0.27; 11.1	0.008	-0.006; 0.023
HIV test	-0.007	-0.03; 0.02	-0.0001	-0.0005; 0.0003
Urine exam	-0.05	-0.32; 0.21	-0.001	-0.006; 0.003
All indicators	0.04	-0.73; 0.80	0.009	-0.050; 0.067

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[1] Collaborations

TR Flores idealized the study, prepared the database, and analyzed the data, described the results, participated in the writing of the complete manuscript. RG Neves assisted in the analysis of the data, in the writing of the methods and discussion and reviewed the final version. GI Mielke and AD Bertoldi participated in review rounds and the final version of the manuscript. BP Nunes prepared the database and assisted in the analysis of the data and reviewed the final version of the manuscript.