Inequalities on coverage of prenatal assistance in Brazil: a nationwide study

Abstract This article aims to evaluate the coverage and inequalities in prenatal assistance. Data from the Brazilian National Health Survey cross-sectional study in 2013. Prenatal assistance assessed through indicators: counseling, guidance received, procedures, and exams performed during the pregnancy. An asset index constructed, the Slope Index of Inequality (SII) and Concentration Index (CIX) were used to measure. About 90% received counseling on healthy eating, not smoking and drinking, 80% not to use dye/hair straightening, and all the advice. Approximately 70% received guidance on delivery and signs of risk and 83.4% for breastfeeding and 60% all the guidelines. About 80% had the measure of pressure and weight checked, the measure of the abdomen and the auscultation of the heart of the baby, only 36.7% had their breasts examined e 33.4% all procedures performed. More than 90% held for HIV and urine and 77.9% for syphilis, 81.4% of women have carried out all the exams and 21.7% all the indicators. No significant absolute differences (SII) found. CIX evidenced in counseling for healthy eating and guidance for breastfeeding. There were no marked inequalities in prenatal assistance.

摘要：本研究旨在评估产前保健服务的覆盖范围与公平性差异。研究数据来源于2013年巴西全国健康调查的横断面研究。本研究通过咨询情况、接受的健康指导、临床操作项目及妊娠期间完成的检查等多项指标，对产前保健服务进行全面评估。本研究构建了资产指数，并采用不平等斜率指数（Slope Index of Inequality, SII）与集中指数（Concentration Index, CIX）开展公平性测度。

结果显示，约90%的研究对象接受了健康饮食、戒烟戒酒相关咨询，80%接受了避免使用染发剂或直发剂的指导；约70%接受了分娩及风险征兆相关指导，83.4%接受了母乳喂养相关指导，60%的研究对象接受了全部指南推荐的健康指导。

约80%的研究对象接受了血压与体重测量、腹部检查及胎儿心脏听诊，仅36.7%接受了乳腺检查，33.4%的研究对象完成了全部产前保健操作项目。

超过90%的研究对象接受了HIV检测与尿液检查，77.9%接受了梅毒检测；81.4%的女性完成了全部规定检查项目，21.7%的研究对象完成了全部指标对应的检测项目。

本研究未发现显著的绝对不平等差异。集中指数（CIX）结果显示，仅在健康饮食咨询与母乳喂养指导方面存在公平性差异。整体而言，本次研究未发现产前保健服务存在显著的公平性差异。