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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2014

Open Access 01-12-2014 | Research article

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

Authors: Ariane Cristina Ferreira Bernardes, Raimundo Antonio da Silva, Liberata Campos Coimbra, Maria Teresa Seabra Soares de Britto Alves, Rejane Christine de Sousa Queiroz, Rosângela Fernandes Lucena Batista, Heloisa Bettiol, Marco Antônio Barbieri, Antônio Augusto Moura da Silva

Published in: BMC Pregnancy and Childbirth | Issue 1/2014

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Abstract

Background

Over 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.

Methods

Data 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.

Results

Only 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.

Conclusions

Despite 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.
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Metadata
Title
Inadequate prenatal care utilization and associated factors in São Luís, Brazil
Authors
Ariane Cristina Ferreira Bernardes
Raimundo Antonio da Silva
Liberata Campos Coimbra
Maria Teresa Seabra Soares de Britto Alves
Rejane Christine de Sousa Queiroz
Rosângela Fernandes Lucena Batista
Heloisa Bettiol
Marco Antônio Barbieri
Antônio Augusto Moura da Silva
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2014
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-14-266

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