Equity and access to health care for pregnant women in Campinas (SP), Brazil

Objective. To compare the health care received during pregnancy, delivery, and the puerperium by women belonging to two different per capita family income strata: less than 1 minimum wage, and 1 or more minimum wages. Method. This is a cross-sectional observational study that was carried out with a random sample of 248 female residents of the city of Campinas, in the state of Sao Paulo, Brasil, who had given birth between April 2001 and March 2002. Socio-demographic data, as well as information concerning maternal morbidity and health care during pregnancy, delivery, and the puerperium, were obtained through home interviews. The Kessner index, the Adequacy of Prenatal Care Utilization index, and an index proposed by the authors based on the recommendations of the Brazilian Department of Health were used to assess the adequacy of prenatal care. The minimum wage in Brazil at the time of the study was 180 reais (approximately 71.4 US dollars). Results. The lower income group included a larger proportion of women with low schooling, as well as adolescents, black women, and single women. Prenatal care was provided by the public Unified Health System to 73.7% of the women in the lower income group, versus 33.3% in the higher income group. The women in the lower income group started attending prenatal care later and had fewer visits in all than higher-income women. However, some health care quality indicators, such as performance of routine laboratory tests and anti-HIV antibody testing, the proportion of cesarean sections, and the frequency of infant rooming-in, showed more favorable figures in the lower income group. Both groups received comparable counseling and had similar rates of clinical testing, post-delivery tubal sterilization, low birthweight children, and premature delivery. Although a significantly higher number of women in the higher income group received optimal prenatal care, the percentage of cases of inadequate care in the lower-income group was still relatively low. The frequency of health problems during pregnancy did not differ significantly between groups, except for anemia and vaginal hemorrhage, which were more frequent among women in the lower-income group (P < 0.001 and P = 0.033, respectively). Conclusions. Despite marked socio-demographic differences between women in the two income categories, resulting in different living conditions, there were no significant differences between groups in terms of health problems during pregnancy or the quality of the prenatal care received. These results suggest that the organization of public health services in Campinas has succeeded in promoting equity in health care, at least to a certain extent.