Inadequate prenatal care utilization and associated factors in São Luís, Brazil

Abstract

BackgroundOver the last decades there has been a reduction of social inequalities in Brazil, as well as a strong expansion of health services, including prenatal care. The objective of the present study was to estimate the rate of inadequate prenatal care utilization and its associated factors in São Luís, Brazil, in 2010 and to determine whether there was a reduction of inequity in prenatal care use by comparing the present data to those obtained from a previous cohort started in 1997/98.MethodsData from the BRISA (Brazilian birth cohort studies of Ribeirão Preto and São Luís) population-based cohort, which started in 2010 (5067 women), were used. The outcome variable was the inadequate utilization of prenatal care, classified according to the recommendations of the Brazilian Ministry of Health. The explanatory variables were organized into three hierarchical levels based on the Andersen’s behavioral model of the use of health services: predisposing, enabling and need factors.ResultsOnly 2.0% of the women did not attend at least one prenatal care visit. The rate of inadequate prenatal care utilization was 36.7%. Despite an improved adequacy of prenatal care use from 47.3% in 1997/98 to 58.2% in 2010, social inequality persisted: both low maternal schooling (prevalence ratio (PR) = 2.78; 95% confidence interval (95% CI) 2.23-3.47 for 0 to 4 years of study) and low family income, less than 0.5 monthly minimum wage per capita (PR = 1.37; 95% CI 1.22-1. 54), continued to be associated with higher rates of inadequate prenatal care utilization. Racial disparity regarding adequate utilization of prenatal services was detected, with black (PR = 1.19; 95% CI 1.04-1.36) and mulatto (PR = 1.14; 95% CI 1.02-1.26) women showing higher rates of inadequate use. On the other hand, women covered by the FHP - Family Health Program (PR = 0.92; 95% CI 0.85-0.98) showed a lower rate of inadequate prenatal care utilization.ConclusionsDespite strong expansion of health services and expressive improvements in adequate prenatal care use and social indicators, inequalities in prenatal care use still persist. The FHP seems to be effective in reducing inadequate prenatal care utilization.

Exploring trend and barriers of antenatal care utilization using data mining:evidence from EDHS of 2000 to 2016

“…As per this finding, the likelihood of using ANC increased along with the change in the household wealth index from poor to rich. This finding was revealed in previous studies that were conducted in Brazil, India and other developing countries [13,22,25]. In fact, Ethiopia has declared ANC services to be provided for free to all mothers in order to avoid the financial barrier those women could encounter while seeking the care.…”

“…In the data selection step, a total of 10 attributes were selected, assuming to have a frequent pattern with ANC utilization based on the review from the previous literature dimensions in which ANC utilization was affected [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. The dependent variable of this study is ANC utilization ("Yes" if the mother receives ANC for at least one time during a pregnancy, or else "No").…”

“…Mother's age [12][13][14][15], place of residence [16][17][18][19], women's education [17,[20][21][22], husband education [19,21], women empowerment [23], women's occupation [24], economic status [13,22,25], parity [18,24], history of pregnancy complication [18,21], and media exposure [26,27]. Even though these factors are from different studies, my study has included and attested all the variables.…”

Family health strategy and equity in prenatal care: a population based cross-sectional study in Minas Gerais, Brazil

“…The role of FHS in the provision of antenatal care was also noticed for other localities in Brazil. Bernardes et al [33] showed that FHS was effective in reducing prenatal care inadequacy. The authors compared prenatal care utilization in São Luis, Maranhão (Northeast region), before (1997/1998) and after FHS implementation (2010).…”

“…Related to antenatal care FHS has contributed to scale up the coverage and to promote an equal access to adequate care [32, 33]. However, Brazil has some of the greatest income inequalities in the world [34].…”