Adequacy of public maternal care services in Brazil

Abstract

BackgroundIn Brazil, hospital childbirth care is available to all, but differences in access and quality of care result in inequalities of maternal health. The objective of this study is to assess the infrastructure and staffing of publicly financed labor and birth care in Brazil and its adequacy according to clinical and obstetric conditions potentially associated with obstetric emergencies.MethodsNationwide cross-sectional hospital-based study “Birth in Brazil: national survey into labor and birth” conducted in 2011–2012. Data from 209 hospitals classified as public (public funding and management) or mixed (public or private funding and private management) that generate estimates for 1148 Brazilian hospitals. Interview with hospital managers provided data for the structure adequacy assessment covering four domains: human resources, medications, equipment for women emergency care and support services. We conducted analysis of the structure adequacy rate according to type of hospital (public or mixed), availability of ICU and the woman obstetric risk using the X 2 test to detect differences in categorical variables with the level of statistical significance set at p <0.05.ResultsGlobal rate of adequacy of 34.8 %: 42.2 % in public hospitals and 29.0 % in mixed hospitals (p < 0.001). Public and mixed hospitals with ICU had higher scores of adequacy than hospitals without ICU (73.3 % × 24.4 % public hospitals; 40.3 % × 10.6 % mixed hospitals). At a national level, 32.8 % of women with obstetric risk were cared for in hospitals without ICU and 29.5 % of women without risk were cared for in hospitals with ICU. Inequalities were observed with the North, Northeast and non-capital regions having the lower rates of hospitals with ICU.ConclusionsThe majority of maternity wards across the country have a low rate of adequacy that can affect the quality of labor and birth care. This holds true for women at high obstetric risk, who suffer the possibility of having their care compromised by failures of hospital infrastructure, and for women at low obstetric risk, who may not receive the appropriate care to support the natural evolution of their labor when in a technological hospital environment.

Maternal Mortality in Brazil: Proposals and Strategies for its Reduction

“…14 Furthermore, the literature shows that reference facilities should be no farther than 20 km away and that smaller maternities with few patients should be avoided when composing the healthcare system, as they present worse perinatal outcomes. 15 A population study on births in Brazil 14 showed that 10% to 24% of low-risk maternities were considered inadequate in terms of physical structure, support services, and human resources to provide quality care. Another example of this inadequacy was presented in a study that observed that obstetricians did not know how to use magnesium sulfate, a drug that is essential to the treatment of hypertensive emergencies in pregnancy, the leading cause of maternal death in Brazil.…”

<b>A estrutura de maternidades como indicador de segurança materna/The maternity structure as a maternal safety indicator<b>

“…Dados semelhantes foram encontrados em pesquisa recente de abrangência nacional (14) , na qual faltavam equipamentos básicos para o atendimento de emergências obstétricas em 40% dos hospitais públicos sem UTI.…”

Expectations, Perceptions and Opinions of Women About the Care Provision During Childbirth

“…15 A pesquisa "Nascer no Brasil" avaliou os estabelecimentos de saúde públicos ou mistos, quanto à sua adequação às requisições das normativas nacionais, e encontrou que apenas 34,5% desses estabelecimentos encontravam-se adequados. 20 Nesse sentido, esse estudo reforça a falta de adequações desses serviços, como reforçado pela fala das mulheres identificadas nesta pesquisa.…”