Access to public health services and integral care for women during the puerperal gravid period period in Ceará, Brazil

Abstract

BackgroundOver time, the Brazilian health system, a growing country, has been developing to ensure good accessibility to health goods and services. This development is focusing on the principle of universality of access and completeness of health care. In this context, we aimed to evaluate the completeness of care and universality of access for women in their pregnancy and puerperal period in Ceará, Brazil.MethodsA descriptive, cross-sectional study based on a quantitative approach, using information collected from the database of the regulation system of the state of Ceará and data from the Prenatal Monitoring System. The research population comprised of 1701 women who delivered a baby in an obstetric reference unit in the Health Macro-Region of Cariri, Ceará, Brazil from January to December 2015.ResultsThere was a high rate of cesarean delivery (49.7%) and a high waiting time for access to high-risk delivery (32.6%) and neonatal intensive care unit (72.9%). There was also a low percentage (41.1%) of pregnant women undergoing an adequate number of prenatal consultations, dental care (20%), educational activities (15%), visits to the maternity ward (0.1%), laboratory tests of the third trimester (29.2%) and puerperal consultation (37.9%).ConclusionsIt was concluded that the Maternal and Child Health Policy, especially the Rede Cegonha, which is still under development, does not ensure access and completeness of care for women during the prenatal, delivery, and puerperal periods, thus violating their reproductive rights. The results of this study allow a critical analysis by the academia and health managers in search of strategies to improve the services of Rede Cegonha in Brazil.

Adesão à consulta puerperal: facilitadores e barreiras

“…11 However, the index found is within the rate pointed out in a literature review study that found adherence rates ranging from 16.8 to 58%. 6,27 This index is far below the desired one, when compared to the data of the United Kingdom, where adherence to the puerperal consultation shows an index of 91%. 27 Low adherence can directly reflect on problems and complications that may arise in the puerperium and turn a routine appointment into a need for emergency care.…”

“…5 The puerperal consultation consolidates assistance to the pregnancypuerperal cycle, in completeness and quality, consisting of an important care indicator. 6 Carrying out the puerperal return is one of the nurse's duties in Primary Health Care and, if lack of postpartum is detected, an active search should be carried out. However, it is noted that there is no standardization in the conduct and that the commitment to carry it out is different.…”

Maternal HIV and syphilis are not syndemic in Brazil: Hot spot analysis of the two epidemics

“…The increasing rates of maternal syphilis over the past decade are likely multi-factorial. Increased syphilis testing and enhanced surveillance as part of the Rede Cegonha and Projeto Nascer campaigns, public policy initiatives aimed at improving prenatal care in Brazil, are possible explanations for increased identification of maternal and congenital syphilis cases throughout the country [ 15 ]. While prenatal care is accessible to all pregnant women under the SUS network in Brazil, the quality may be suboptimal, particularly among women of a lower socioeconomic status [ 30 ].…”

“…Since 2014, a total of 11 countries received WHO validation for dual elimination of HIV and syphilis MTCT [ 14 ]. In response to the PAHO goal of dual elimination, several public policies were implemented in Brazil to increase testing capacity and treatment [ 15 ]. Despite these efforts, rates of maternal and congenital syphilis continue to climb in Brazil.…”

Access to care during labor and delivery and safety to maternal health

“…And, when one evaluated the right of universality in the access of women during pregnancy and the puerperium it was found that the federal policy on maternal and child health has weaknesses in access to care for women in prenatal care, childbirth and the puerperium, therefore a study recommended that managers prioritize actions to improve this policy to guarantee access to health of the binomial (20) . Similar results were found in researches that showed that women who received information on pregnancy and childbirth were significantly more likely to know any danger signs, compared to women who did not receive information (21) ; and identified a low level of women's knowledge about obstetric danger signs during pregnancy, childbirth and postpartum, finding that women who were unaware were more susceptible to delay in deciding to seek care.…”