Fatores associados à adequação do pré-natal no Brasil

Abstract

The work aims to classify the adequacy of prenatal care in Brazil at different levels of complexity and identify assistance, demographic, socioeconomic and behavioral factors associated with inadequacy of this assistance. For this work, the PNDS - 2006 database, with information provided by the mothers of 5,958 births in the five geographical regions of Brazil, was used. Using the PHPN criteria, levels of adjustments and classification into appropriate and inappropriate were defined. Three complementary and increasingly complex levels that are based on relatively reviewed the use of prenatal care (beginning and number of queries), the clinical and obstetric procedures (measurement of blood pressure, fundal height and maternal weight) and basic laboratory tests (blood, urine, and tetanus vaccine). To check the significance of the association between factors and levels, chi-square tests were applied, considering the sample weights, to verify the adequacy associated factors. Significant factors were included in multivariate models of binomial logistic regression. The percentages of inadequacy presented by the levels were (23.2 %) for level one (34.7 %) and for the level two (59.1 %) to level three. Factors that showed significant associations were greater socioeconomic and behavioral. Women with a family income higher than three minimum wages and greater access to goods and services had lower percentages of inadequacy. The fact that the mother does not wish to have the child or to wish for the future, proved to be of great relevance to the inadequacy of prenatal care services. The results may inform the design of public policies that the adequacy of prenatal care, expanding access and the establishment of procedures and actions whose primary purpose is to monitor and promote the link between outpatient care and delivery, thus meeting the SUS guidelines and PHPN criteria.