Factors associated with the involuntary pilgrimage for childbirth care in Sao Luis (Maranhao State) and Ribeirao Preto (Sao Paulo State), Brazil: a contribution from the BRISA cohort

The objectives of this study were to estimate the in- voluntary pilgrimage by women in labor in search of childbirth care and to identify factors associated with this endeavor in two Brazilian cities. This was a cross-sectional study nested in the BRISA birth cohort, whose sample consisted of 10,475 women admitted to the selected maternity hospitals for delivery in Sao Luis (Maranhao State) and Ribeirao Preto (Sao Paulo State). Interviews were held with questionnaires that contained sociodemographic and obstetric variables. Hierarchical modeling was used, and relative risk was calculated with Poisson regression. Involuntary pilgrim- age during labor was more frequent in Scio Luis (35.8%) than in Ribeirao Preto (5.8%). In Sao Luis, factors associated with pilgrimage were: first pregnancy (RR = 1.19; 9.5%CI: 1.08-1.31) and schooling less than 12 complete years. However, age 35 years or older (RR = Q65 9.5%CI: 0.54-0.84) was associated with less pilgrimage. In Ribeirao Preto, such trekking for obstetric care was more frequent in women with high-risk pregnancies (RR = 2.45; 9.5%CI: 1.81-3.32) and those with gestational age less than 37 weeks (RR = 1.93, 9.5%CI: 1.50-2.50). Meanwhile, delivery with gestational age equal to or greater than 42 weeks was associated with less pilgrimage (RR = 0.57; 95%CI: 0.33-0.98). In both cities, poor women had to trek more in search of childbirth care and had no guarantee of care, even for those who had received prenatal care. The study revealed the lack of guarantee of universal and equitable access and highlighted the unequal access to childbirth care between Brazil's major geographic regions.