Women who seek health facilities for childbirth expect to have a safe environment, skilled professionals, and respect during their care. However, many patients are mistreated during labor and delivery in health care facilities around the world. 1,2 In addition to the suffering caused to women and their families, there is a consensus that this phenomenon negatively influences the quality of care provided and it also acts as a barrier to future health care utilization. [3][4][5] Declared by the World Health Organization (WHO) in 2015 as a public health problem and a violation of women's fundamental human rights, 6 disrespect and abuse during childbirth are considered central components to improve maternal and child health. 7

Objectives: to evaluate the structure and adequacy of maternal healthcare facilities in Piauí. Methods: cross-sectional study in 26 hospitals with more than 200 births/year between 2018-2019. The structure was assessed by direct observation and interview with manager, in four domains: physical aspects, human resources, equipment, and drugs. Fisher’s chi-square/exact tests were used to assess differences in adequacy of structure. Results: only 46.2% of the maternal healthcare facilities had pre-delivery, parturition and immediate post-partum room. Pediatricians (73.1%) and anesthesiologists (61.5%) were the least present professionals on-duty regime. Regarding drugs, magnesium sulfate and oxytocin were observed in 76.9% of hospitals. Overall adequacy was 23.1%, being higher in maternal healthcare facilities in the capital (p=0.034) and in private ones (p=0.031). Conclusions: Data show inequalities in the structure of maternity hospitals of the state. The absence of health professionals, essential drugs, and appropriate physical structure can expose women and newborns to unnecessary and avoidable risks.