Abstract
ABSTRACTOBJECTIVETo estimate the adequacy of health care during pregnancy and the postpartum period in puerperal women and newborn users of the Unified Health System and verify the factors associated with greater adequacy.METHODSWe used data obtained in the hospital interview, the prenatal card and the first telephone interview of 12,646 women participating in the study Nascer no Brasil (Birth in Brazil), conducted in 2011 and 2012. In the first stage of the analysis, the sociodemographic and obstetric characteristics of women and the estimation of adequacy of prenatal and postpartum care indicators are described. In the second stage, the cascade of care for actions related to puerperal women and their newborns is presented. Finally, maternal factors associated with the adequacy of the line of care are verified by means of multiple logistic regression.RESULTSOnly two of the four prenatal indicators were considered satisfactory: initiation up to the 16th week of pregnancy and adequate number of appointments. The guidance on which maternity to go for delivery, as well as the guidance to perform the puerperal appointment and the performance of the heel prick test have reached partial level of adequacy. The puerperal appointment, the first routine appointment of the newborn and the obtaining of the heel prick test results presented unsatisfactory adequacy. In the joint analysis of indicators regarding the effective use of services, only 1.5% of mothers and their babies received all recommended health care. Multiparous women living in the North, Northeast and Midwest, with lower schooling, presented the lowest chances of continuity of care.CONCLUSIONSThe indicators evaluated indicate that almost all women and their children presented partial and disjointed care, showing that the coordination of care is still a challenge in the health care of women and children in the puerperal pregnancy period.
Highlights
The puerperal period, known for its association with vulnerability in women and children, has been contemplated with strategies aimed at expanding access and use of health services for the protection of this population
The indicators evaluated indicate that almost all women and their children presented partial and disjointed care, showing that the coordination of care is still a challenge in the health care of women and children in the puerperal pregnancy period
Continuity of care is a multifaceted concept that in the international literature generally refers to individual care in the field of primary care but is understood in the sphere of health service management
Summary
The puerperal period, known for its association with vulnerability in women and children, has been contemplated with strategies aimed at expanding access and use of health services for the protection of this population Among such strategies, we seek the articulation of services, in order to build care networks to guarantee the continuity of care[1]. In the postulates of Starfield[4], continuity of care is discussed in the scope of care coordination and operates with the underlying idea of uninterrupted succession of the health care process to a given problem. It refers to the ability of the health system to organize services regarding clinical records and the personnel responsible for care, in addition to the users’ perception of the extent of care
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