Assessment of prenatal care for indigenous women in Brazil: findings from the First National Survey of Indigenous People’s Health and Nutrition

Abstract: This study assesses prenatal care for indigenous women 14-49 years of age with children under five years of age in Brazil. The First National Survey of Indigenous People’s Health and Nutrition assessed 3,967 women who met these criteria, of whom 41.3% in the North, 21.2% in the Central, 22.2% in the Northeast, and 15% in the South/Southeast. Prenatal care was offered to 3,437 (86.6%) of these women. The North of Brazil showed the highest proportion of indigenous women who did not receive prenatal care. Coverage was 90.4%, but only some 30% began prenatal care in the first trimester, and only 60% of the eligible women were vaccinated for diphtheria and tetanus. Only 16% of indigenous pregnant women had seven or more prenatal visits. Access to at least one clinical-obstetric consultation was found in 97% of the records, except for breast examination (63%). Laboratory test rates were low (blood glucose 53.6%, urinalysis 53%, complete blood count 56.9%, Pap smear 12.9%, syphilis test 57.6%, HIV serology 44.2%, hepatitis B 53.6%, rubella 21.4%, and toxoplasmosis 32.6%), as was prescription of ferrous sulfate (44.1%). As a whole, the proportion of orders for recommended laboratory tests was only 53%. The percentages of prenatal care procedures for indigenous women are lower than for non-indigenous Brazilian women as a whole, and are even lower than among women in regions with high social vulnerability and low healthcare coverage, like the Legal Amazonia and the Northeast. The results confirm the persistence of ethnic-racial inequalities that compromise the health and well-being of indigenous mothers.

摘要：本研究针对巴西14至49岁、育有5岁以下子女的原住民女性的产前保健（prenatal care）服务开展评估。首次全国原住民健康与营养调查（First National Survey of Indigenous People’s Health and Nutrition）共纳入符合上述标准的女性3967名，其中北部地区占比41.3%、中部地区21.2%、东北部地区22.2%、南部与东南部地区15%。其中3437名女性（占比86.6%）接受了产前保健服务。巴西北部地区未获得产前保健的原住民女性占比最高。本次调查的产前保健覆盖率达90.4%，但仅约30%的女性在妊娠首三个月即启动产前保健，仅60%的符合条件女性完成了白喉（diphtheria）与破伤风（tetanus）疫苗接种。仅16%的原住民孕妇完成了7次及以上产前保健随访。97%的就诊记录显示女性至少接受过1次临床产科咨询，但乳腺检查的完成率仅为63%。实验室检测率普遍偏低：血糖检测53.6%、尿液分析53%、全血细胞计数56.9%、巴氏涂片（Pap smear）12.9%、梅毒（syphilis）检测57.6%、HIV血清学检测44.2%、乙型肝炎（hepatitis B）检测53.6%、风疹（rubella）检测21.4%以及弓形虫病（toxoplasmosis）检测32.6%；硫酸亚铁（ferrous sulfate）处方率同样仅为44.1%。整体而言，推荐实验室检测项目的实际完成率仅为53%。巴西原住民女性的产前保健服务完成比例整体低于非原住民女性，甚至低于社会脆弱性高、医疗保健覆盖率较低的地区（如法定亚马逊地区（Legal Amazonia）与东北部地区）的女性群体。本研究结果证实，损害原住民母亲健康与福祉的族裔与种族不平等现象依然存在。