Eqüidade na atenção pré-natal e ao parto em área da Região Metropolitana de São Paulo, 1996

Abstract

A cross-sectional study was conducted to evaluate prenatal and childbirth care interviewing mothers of infants in the municipality of Embu (Greater Metropolitan São Paulo) in 1996, according to four socioeconomic strata. A door-to-door survey included a probabilistic sample consisting of 483 infants. In all strata more than 90% of the mothers had received prenatal care, but with late access in stratum 4 (residents of favelas, or slums). Breast examination during prenatal care, reported by only 60.8% of the mothers, was the worst single indicator of quality of prenatal care in the municipality. The outcome indicator - first prenatal consultation after the first trimester and total number of consultations less than six - was associated with maternal age (less than 20 years), low per capita family income (less than one minimum wage), and lack of private health plan. As for deliveries, 97.7% occurred in hospital, of which 32.5% by cesarean section, with the latter more frequent in private health care facilities (63.2%). No population segments were identified as being excluded from the health care system, but some indicators suggest greater deficiencies in socioeconomic stratum 4. These results have supported local health system managers in redefining health measures for the municipality.

Incidence of congenital syphilis in the South Region of Brazil

“…One case-control study conducted in Porto Alegre in 1998-2000 disclosed the relevance of certain socioeconomic characteristics (black ethnicity and low maternal educational level) as risk factors for congenital syphilis following adjustment for the variables representing access to prenatal care. Thus, although the fact that women under highly vulnerable conditions tend to attend few prenatal care visits is well established, this pattern might be due to factors that are not associated with prenatal care and that cause social inequalities to be associated with different risks of congenital syphilis 19 . Such factors include the following: insuffi cient transportation resources to laboratories and healthcare centers; a lack of social support, particularly from the women's partners; and unsafe sex practices, which increase the risk for recurrent T. pallidum infections 20 .…”

Exame clínico das mamas em consultas de pré-natal: análise da cobertura e de fatores associados em município do Rio Grande do Sul, Brasil

“…Em termos de comparação, a cobertura encontrada em Rio Grande foi inferior àquela encontrada em outras cidades do país. Estudos realizados em Pelotas (Rio Grande do Sul), Embu (São Paulo) e Criciúma (Santa Catarina), observaram uma freqüência do exame clínico das mamas no pré-natal de 61,3%, 62,9% e 50,6%, respectivamente 13,17,18 . 1,19,20 .…”

“…Segundo Puccini et al 13 , para gestantes com baixa renda, idade inferior a vinte anos e falta de acesso a plano privado de saúde, existe maior probabilidade de receberem assistência pré-natal de qualidade inferior.…”

“…Apesar da alta cobertura pré-natal encontrada, observam-se desigualdades nos cuidados oferecidos às grávidas 12 . A situação traduz a inefetividade dos serviços de saúde para garantir um atendimento adequado não apenas em relação ao número de consultas, mas também ao conteúdo do atendimento oferecido 10,13 .…”

“…A própria literatura especializada tem privilegiado a análise das características e dos resultados da assistência pelo número de consultas pré-natais e tipo de parto, relegando a um segundo plano o estudo da qualidade do conteúdo das consultas. Embora esse tipo de avaliação retrate com maior fidelidade o processo do atendimento 12,13,14 .…”