Racial inequalities and perinatal health in the southeast region of Brazil

Silva, L. M.; Silva, R. A.; Silva, A. A. M.; Bettiol, Heloísa; Barbieri, Marco Antônio

doi:10.1590/s0100-879x2006005000144

Cited by 26 publications

(22 citation statements)

References 18 publications

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“…With respect to income, although there was a difference, it was small as expected since women in this group are more affl uent. The negative association between cesarean delivery and skin color has been described in other studies, 10,21 and for other child and mother outcomes, 3,13,20 and is explained by poor quality of prenatal care and socioeconomic disadvantages. However, it should be noted that it remains a factor in the model that exclusively analyzed the private sector, even after adjustment for income.…”

Section: Discussionsupporting

confidence: 62%

Risk factors for cesarean section by category of health service

et al. 2010

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OBJECTIVE:To analyze the rate of cesarean section and differences in risk factors by category of health service, either public or private. METHODS:A cross-sectional study was carried out including all pregnant women in labor admitted to hospitals in the city of Rio Grande, Southern Brazil, between January 1 and December 31, 2007. A pre-coded and pretested questionnaire was used to collect on social, demographic, obstetric and newborn care information. Two regression models were constructed: one for public users and the other one for private ones. Poisson regression was used in each model in the multivariate analysis. Prevalence rates and 95% confi dence intervals were calculated for each adjusted factor. RESULTS:The rate of cesarean section was 43% and 86% among public and private users. Sociodemographic factors and twin births have a more signifi cant impact among public users as well as number of pregnancies (25% vs. 13% reduction in public and private users, respectively) and previous cesarean section (86% vs. 24% increase in public and private users, respectively). Prenatal care visits and hospital admissions affected the outcome only in women users of public services. CONCLUSIONS:Cesarean section rates were high in both groups studied, but it was twice as high among women cared in the private sector. Associated factors differ in magnitude by category of service used. Some of the reasons associated with this high rate are related to health service characteristics.22,25 A recent study of the Brazilian National Supplemental Health Agency (ANS, which regulates private insurance) reported that cesarean section rates among privatelyinsured women were as high as 80% in 2006 a while it is was 26% in the public Brazilian National Health System (SUS), b a rate that is high but closer to that recommended.Although the same surgical procedure is performedand sometimes they are performed by the same doctors RESUMO OBJETIVO: Analisar a taxa de cesárea e fatores associados à sua ocorrência segundo serviço de saúde utilizado, público ou privado. MÉTODOS:Foi realizado estudo transversal entre 1º de janeiro e 31 de dezembro de 2007 com todas as gestantes que deram à luz nos hospitais da cidade de Rio Grande, RS. As gestantes foram entrevistadas, utilizando-se um questionário testado e pré-codifi cado com questões sociodemográfi cas, obstétricas e relacionadas ao recém-nascido. Foram desenvolvidos dois modelos de predição, um para as gestantes internadas pelo Sistema Único de Saúde (público) e outro para as gestantes internadas em serviços privados. Em cada modelo foi realizada uma análise multivariada utilizando a regressão de Poisson, calculando-se as razões de prevalência e seus respectivos intervalos com 95% de confi ança. RESULTADOS:A taxa de cesárea para o grupo público foi 43% enquanto no grupo privado foi 86%. Os fatores sociodemográfi cos e o parto gemelar foram mais importantes no modelo público, assim como o número gravidezes (redução de 25% vs. 13% no grupo privado) e cesárea prévia (incremento de 86% vs. ...

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Section: Discussionsupporting

confidence: 62%

Risk factors for cesarean section by category of health service

et al. 2010

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“…Although errors of hetero-classification may not be completely discarded, the change in the ethnic profile of the pregnant population may impact unfavorably the prevalence of low-birthweight, pre-term, and small-for-gestational age babies 18 .…”

Section: Variablementioning

confidence: 99%

Mothers and their pregnancies: a comparison of three population-based cohorts in Southern Brazil

et al. 2008

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Mothers from the 1982, 1993 and 2004 Pelotas birth cohorts were compared across biological, socioeconomic, demographic and reproductive characteristics. Women in the 2004 cohort had higher levels of education, gained more weight during pregnancy, and were heavier at the beginning and end of their pregnancy than mothers who gave birth in 1993 and 1982. There was an important increase in obesity rates (body mass index > 30kg/m²) over the 22 years of the study. Mean parity decreased from 1.3 in 1982 to 1.1 in 2004, with a growing proportion of primiparas and a decline in the proportion of women with > 4 children. The mean birth interval increased from 33.5 months in 1982 to 65.7 in 2004. Smoking during pregnancy decreased from 35.6% in 1982 to 25.1% in 2004. As with other characteristics, the change in smoking status differed according to income, with higher reductions among the wealthiest (from 24.9% to 8.7%) than among the poorest mothers (from 43.7% to 33.6%). In general terms, between 1993 and 2004 there was a decrease in the prevalence of maternal risk factors for unfavorable perinatal outcomes.

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“…The disparities we find are consistent with those from other studies in Brazil. (35,65) For example, Barros et al report a 14-24% increased likelihood of LBW and PTB among non-white infants compared to white infants in Southern Brazil. (35) However, our study is the first to formally decompose these disparities in Brazil and quantify how they relate to demographic, socioeconomic, healthcare, and geographic differences.…”

Section: Discussionmentioning

confidence: 99%

“…(37,41,57,58,63) Notable disparities in the number and quality of prenatal care visits exist between white and black/mixed race women in Brazil. (5,6,64,65) Demographic characteristics include a binary indicator for infant sex, continuous maternal and paternal age variables, and age squared. In addition to their direct effects on infant health (especially in the case of infant's sex and maternal age), these characteristics also influence parental health preferences and behaviors.…”

Section: Study Measures and Empirical Modelmentioning

confidence: 99%

Explaining Racial Disparities in Infant Health in Brazil

et al. 2015

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Objective-Racial disparities in infant health are common in Brazil. Explaining these disparities and identifying the pathways through which they arise is essential for identifying risk factors that can be targeted by policy interventions. Our objective is to quantify the extent to which socioeconomic, healthcare, demographic, and geographic effects explain racial disparities in low birth weight (LBW) and preterm birth (PTB) rates in Brazil.Methods-We employ a sample of 8949 infants born between 1995 and 2009 in 15 cities and 7 provinces in Brazil. We focus on disparities in LBW (< 2500 grams) and PTB (< 37 gestational weeks) prevalence between infants of African ancestry alone or mixed with other ancestries on one side, and infants of European ancestry alone on the other. We quantify the contributions of several conceptually relevant factors to these disparities using a decomposition model. Findings-The model explains 45-94% and 64-94% of the LBW and PTB disparities, respectively, between the various African ancestry groups and European ancestry. Differences in prenatal care use and geographic location are generally the most important contributors to these disparities, followed by socioeconomic differences. The model explains the majority of the disparities for mixed African ancestry and part of the disparity for African ancestry alone.Conclusions-Prenatal care and geographic location differences explain a large portion of the health disparities between infants of African and European ancestries. Public policies aiming at improving child health should target these pathways in order to reduce such disparities.

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Racial inequalities and perinatal health in the southeast region of Brazil

Cited by 26 publications

References 18 publications

Risk factors for cesarean section by category of health service

Risk factors for cesarean section by category of health service

Mothers and their pregnancies: a comparison of three population-based cohorts in Southern Brazil

Explaining Racial Disparities in Infant Health in Brazil

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