Economic and racial inequalities in the prenatal care of pregnant teenagers in Brazil, 2011-2012

Abstract

Objectives: to analyze the prenatal care of pregnant teenagers interviewed in the post-partum period in Brazilian maternity hospitals, according to economic status and skin color. Methods: data were obtained from the Birth in Brazil study, a national hospital-based survey in 2011 and 2012. Information was obtained from interviews with the postpartum women and from data collected from their prenatal cards. Multivariate logistic regression was used to verify whether maternal and prenatal care characteristics were associated with ina-dequate prenatal care. Results: a total of 3,317 teenage mothers were interviewed in the postpartum period, 84.4% of whom had received inadequate prenatal care, with worse results for lower-income, lower-schooling, and multiparous teens. In the same way, it became evident the higher proportion of black teenagers and those from economic classes D/E among those who failed to receive routine laboratory tests, who received little orientation on the pregnancy, labor, and childbirth, and who were forced to go from one maternity hospital to another before being admitted to give birth. Conclusions: strategies targeted to the most vulnerable pregnant teenagers should be implemented in order to achieve greater equality in teenagers’ prenatal care, seeking to assure easier access, earlier initiation of care, and greater case-resolution capacity

Strategies For Strengthening High Risk Pregnancy Care In Primary Healthcare Services

“…Although the results suggest that the ESF and mixed units have greater opportunity to perform care for pregnant women of black or brown color, 19 it is pointed out that these groups of pregnant women are unable to perform the recommended routine examinations, they have more commute during childbirth, have a reduced number of prenatal consultations 20 and overall have higher rates of inadequacy for prenatal care 21,22 . This situation reinforces the discussions presented that expanding access to prenatal care was not sufficient for inducing quality care 23 , and although EFS and mixed units are able to strengthen the continuity of care between services, they may not be able to effect care for pregnant women.…”

“…Late prenatal intake reduces the chances of risk identification and timely intervention of complications 19,28 , triggering alarm in health teams and moving various resources such as HV and CHA to maintain surveillance. This situation may be the explanatory hypothesis for the findings.…”

Adolescentes grávidas que experienciaram o nascimento prematuro: percepções acerca do cuidado pré-natal

“…O pré-natal, além de ter o objetivo de avaliar e acompanhar a saúde da mulher e de sua criança 14 , deve considerar o suporte ao processo de parentalidade e de empoderamento da mulher, inclusive no que tange ao parto. Assim como neste estudo, a literatura brasileira reforça incipiências na assistência de adolescentes grávidas, com destaque para a limitação do cuidado quando a assistência se restringe aos aspectos biológicos da gestação, desconsiderando os aspectos mais amplos relacionados à gestante e sua família 15,16 .…”

Trends in fertility rates, proportion of antenatal consultations and caesarean sections among Brazilian adolescents

“…This high coverage can be explained by the strategies implemented by the Ministry of Health, such as the FHS, the creation of the National Program for Humanization in Antenatal and Birth (PHPN) and the Stork Network (20)(21) . Although there has been an increasing trend in the proportion of seven or more consultations, studies show that the highest proportion of inadequate antenatal care, such as late start and inadequate number of consultations, occurs among adolescents, especially those with less education and low socioeconomic status, when compared to adult pregnant women (24)(25)(26) . A study that evaluated the antenatal care of pregnant adolescents in Brazil showed that 84.4% received inadequate care during antenatal period, with worse results for those of lower economic class, black/brown, with inadequate schooling for their age, who lived in the North and Northeast Regions and who were multiparous (26) , corroborating the regional inequalities of access found in this study.…”