Abstract
This study analyzed the social and geographical inequalities in the performance of prenatal medical care in the Unified Health System (SUS) in the Metropolitan Region of Grande Vitória, Espírito Santo, Brazil. A cross-sectional study was carried out with 1,209 puerperae living in this region, admitted for childbirth from 2010 to 2011. Data about prenatal care and contextual, enabling, and social characteristics were collected, following the Andersen's Behavioral Model. The performance of prenatal care was classified into five levels, including information on the number of prenatal visits, initial and repetitive examinations, tetanus vaccination, gestational risk management, and participation in educational activities. The likelihood of different levels of prenatal care performance was analyzed using a multivariate multinomial model, according to maternal social variables. High prenatal coverage (98%) and 4.4% care adequacy were identified. The likelihood of access to prenatal care was increased by enabling, contextual, and social factors. The relationship between prenatal care quality and pregnant women's social and geographical conditions must be considered in the organization of services to achieve equity and reduce maternal and perinatal morbimortality.
Highlights
The performance of services is an essential indicator of a health system structure, which must be organized to favor the use of those in need
It is noteworthy that the criterion used in this study aimed to consider the procedures indicated in the PHPN in its breadth and the low percentage at the third level of performance, which represents the completion of all the procedures analyzed, provided for in prenatal care[24]
We observed that the high coverage of prenatal care does not necessarily translate into an improved quality of care
Summary
The performance of services is an essential indicator of a health system structure, which must be organized to favor the use of those in need. The definition of equity in health, in general, is close to the idea of social justice, in ethical terms, and of human rights[1,2,3,4] In this sense, the way society is organized and developed can reduce the opportunity for some people to achieve a good level of health, which would characterize an unfair situation[3]. The underlying intermediate determinants include living conditions, the psychosocial aspects, the biological/genetic, and behavioral factors of the individuals and the health system The configuration of the latter is what defines the pattern of access to health care for different social groups and, when it incorporates the differences in exposure, disease, and social vulnerability of the population, through intersectoral actions, it can minimize such differences in people’s lives[5]
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