Family health strategy and equity in prenatal care: a population based cross-sectional study in Minas Gerais, Brazil

Abstract

BackgroundPrenatal care coverage is still not universal or adequately provided in many low and middle income countries. One of the main barriers regards the presence of socioeconomic inequalities in prenatal care utilization. In Brazil, prenatal care is supplied for the entire population at the community level as part of the Family Health Strategy (FHS), which is the main source of primary care provided by the public health system. Brazil has some of the greatest income inequalities in the world, and little research has been conducted to investigate prenatal care utilization of FHS across socioeconomic groups. This paper addresses this gap investigating the socioeconomic and regional differences in the utilization of prenatal care supplied by the FHS in the state of Minas Gerais, Brazil.MethodsData comes from a probabilistic household survey carried out in 2012 representative of the population living in urban areas in the state of Minas Gerais. The sample size comprises 1,420 women aged between 13 and 45 years old who had completed a pregnancy with a live born in the last five years prior to the survey. The outcome variables are received prenatal care, number of antenatal visits, late prenatal care, antenatal tests, tetanus immunization and low birthweight. A descriptive analysis and logistic models were estimated for the outcome variables.ResultsThe coverage of prenatal care is almost universal in catchment urban areas of FHT of Minas Gerais state including both antenatal visits and diagnostic procedures. Due to this high level of coverage, socioeconomic inequalities were not observed. FHS supplied care for around 80% of the women without private insurance and 90% for women belonging to lower socioeconomic classes. Women belonging to lower socioeconomic classes were at least five times more likely to receive antenatal visits and any of the antenatal tests by the FHS compared to those belonging to the highest classes. Moreover, FHS was effective in reducing low birthweight. Women who had prenatal care through FHS were 40% less likely to have a child with low birthweight.ConclusionThis paper presents strong evidence that FHS promotes equity in antenatal care in Minas Gerais, Brazil.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0503-9) contains supplementary material, which is available to authorized users.

O SUS na vida dos brasileiros: assistência, acessibilidade e equidade no cotidiano de usuários da Atenção Primária à Saúde

“…Posteriormente, o enfoque na igualdade dos cidadãos foi substituído pela ênfase na redução das disparidades sociais e regionais existentes no país. Contudo, estudos de base populacional dedicados a analisar características de desigualdades são escassos (ALBRECHT; ROSA; BORDIN, 2017;ANDRADE et al, 2017).…”

Longitudinalidade do cuidado na atenção primária: avaliação na perspectiva dos usuários

“…Longitudinality was evaluated with low scores in municipalities with higher HDI, which may be related to population size, considering that large municipalities of the region studied are those with the highest HDI (13) , but the lowest FHS coverage. The presence of a satisfactory score for the longitudinality among the municipalities with greater FHS coverage reinforces the role of this model as provider and reorganizer of PHC (8) . Increasing FHS coverage is one of the challenges to consolidate PHC, and the expansion of PHC can lead to satisfactory results in terms of improving health indicators, especially among the most vulnerable equity in health (8,31) .…”

“…Para la comparación de promedios se utilizó la prueba Mann-Whitney y Kruskal Wallis. Resultados: El nivel de afi liación fue evaluado con alta puntuación (8,6; IC95%:8,5-8,8) y la longitudinalidad obtuvo una puntuación insatisfactoria (6,4; IC95%:6,3-6,5). Las debilidades relacionadas al atributo fueron la relación interpersonal entre el usuario y el profesional, el reconocimiento del usuario en su integralidad y la preparación de los profesionales para dar auxilio a los usuarios.…”

“…(5) In Brazil, PHC has included the provision of different health care models, for example, the traditional model that has been replaced over the years by the FHS. The FHS is being adopted as a model to expand and reorganize PHC according to SUS guidelines, highlighting its more positive performance in relation to the quality of primary care, (3,6,7) access to and use of the service, promoting equity (8,9) and better health outcomes for the population, (10)(11)(12) in comparison with the traditional model.…”

Maternal and Child Health in Underdeveloped Areas and State Borders

“…The expenses incurred by the family because family members are sick can result in disruption of the family economy 2 . A study and the results stated that the degree of family health can be improved if you pay attention to the health elements of vulnerable family members, such as mothers and children, especially in terms of maternal ANC services, family socioeconomic status, as well as regional access disparities 3 .…”