Antenatal care in Southern Brazil: Coverage, trends and inequalities

Abstract

We described prenatal care quality for four indicators over a 12-years period among puerperae living in Southern Brazil. Five surveys including all women giving birth between 01/01 to 31/12 in 2007, 2010, 2013, 2016, and 2019 were conducted in Rio Grande, Rio Grande do Sul state, Brazil. A single standardized questionnaire was applied within 48 h after delivery in all the city's maternity hospitals. Outcomes included the followings proportion of pregnant women who started prenatal care in the first trimester and performed at least six medical visits, completed at least two HIV, two syphilis and two qualitative urine tests. These indicators were stratified according to quartiles of household income. Absolute and relative measures of inequalities were calculated. A total of 12,645 (98% of the total) of the 12,914 mothers eligible in the five surveys were successfully interviewed. Coverage for all indicators increased substantially, especially in the poorest quartile for six prenatal care visits starting in the first trimester, and for HIV and qualitative urine tests. The slope index (SII) and the concentration index (CIX) of inequality showed clear disadvantage among the poorest for prenatal visits starting in the first trimester and performing two or more urine tests. There was a substantial increase in coverage for all variables studied in the period. The reduced inequity, mainly for the beginning of the first trimester and for visits and urine tests, was due to the higher coverage achieved in the poorest quartile.

Keywords: Absolute inequality; Antenatal care; Brazil; Concentration index; Health care disparities; Inequity; Relative inequality; Socioeconomic inequity.