Prenatal care in Brazil Assistência pré-natal no Brasil El cuidado prenatal en Brasil

This study aims to describe prenatal care provided to pregnant users of the public or private health services in Brazil, using survey data from Birth in Brazil, research conducted from 2011 to 2012. Data was obtained through interviews with postpartum women during hospitalization and information from hand-held prenatal notes. The results show high coverage of prenatal care (98.7%), with 75.8% of women initiating prenatal care before 16 weeks of gestation and 73.1% having six or more number of appointments. Prenatal care was conducted mainly in primary health care units (89.6%), public (74.6%), by the same professional (88.4%), mostly physicians (75.6%), and 96% received their hand-held prenatal notes. A quarter of women were considered at risk of complications. Of the total respondents, only 58.7% were advised about which maternity care service to give birth, and 16.2% reported searching more than one health service for admission in labour and birth. Challenges remain for improving the quality of prenatal care, with the provision of effective procedures for reducing unfavourable outcomes. Prenatal Care; Maternal and Child Health; Maternal-Child Health Services Resumo O estudo tem por objetivo analisar a assistência pré-natal oferecida às gestantes usuárias de serviços de saúde públicos e/ou privados utilizando dados da pesquisa Nascer no Brasil, realizada em 2011 e 2012. As informações foram obtidas por meio de entrevista com a puérpera durante a internação hospitalar e dados do cartão de prénatal. Os resultados mostram cobertura elevada da assistência pré-natal (98,7%) tendo 75,8% das mulheres iniciado o pré-natal antes da 16a semana gestacional e 73,1% compareceram a seis ou mais consultas. O pré-natal foi realizado, sobretudo, em unidades básicas (89,6%), públicas (74,6%), pelo mesmo profissional (88,4%), em sua maioria médicos (75,6%), e 96% receberam o cartão de pré-natal. Um quarto das gestantes foi considerado de risco. Do total das entrevistadas, apenas 58,7% foram orientadas sobre a maternidade de referência, e 16,2% procuraram mais de um serviço para a admissão para o parto. Desafios persistem para a melhoria da qualidade dessa assistência, com a realização de procedimentos efetivos para a redução de desfechos desfavoráveis. Cuidado Pré-Natal; Saúde Materno-Infantil; Serviços de Saúde Materno-Infantil http://dx.doi.org/10.1590/0102-311X00126013 Viellas EF et al. S2 Cad. Saúde Pública, Rio de Janeiro, 30 Sup:S1-S15, 2014 Introduction Prenatal care is an important component of health care for women during pregnancy. Practices routinely performed during this care are associated with better perinatal outcomes 1,2. According to recommendations of the Ministry of Health 3, prenatal care should be through the incorporation of welcoming reception; development of educational and preventive actions without unnecessary interventions, early detection of diseases and identification of gestational risk; establishment of the link between prenatal care and place of birth, and easy access to quality health services from primary care to hospital care of high risk women. National studies have demonstrated the existence of gaps in prenatal care, such as difficulties in access, late booking, inadequate number of prenatal visits and incomplete realization of the recommended procedures, affecting the quality and effectiveness of care 4,5,6. The lack of linkage between the services providing prenatal and delivery care is another problem identified, resulting in the pilgrimage of pregnant women in labour in search of a place for hospitalization, bringing additional health risks to the pregnant woman and her newborn 7,8. Nationwide data about prenatal care in Brazil is scarce. The information from the Information System on Live Births (SINASC) demonstrate an increase in prenatal coverage in the country, reaching values close to 100% in 2011 (Health Informatics Department. http://www.datasus. gov.br, accessed on 01/Jul/2013). However, this system only allows the analysis of the number of appointments conducted, and is restricted to pregnancies that resulted in a live birth. The System of Information of the Program for the Humanization of Prenatal and Birth Care – SispreNatal (http://sisprenatal.datasus.gov.br/SISPRENATAL/index.php), implemented in the year 2000, allows access to other information, such as gestational age at onset of prenatal care, routine exams, anti-tetanus vaccination, number of prenatal visits and postpartum appointments. However, this data is not available for regular consultation and presents problems with underreporting 9. The only study that evaluated prenatal care using data from this system for the entire country was conducted with pregnant women enrolled in the first two years of the program (2001 2002) when less than 30% of expectant mothers were enrolled 10. Specific studies, such as the Brazilian National Survey of Demographic and Health (PNDS), also provide data on prenatal care in the country. The most recent one, held in 2006 11, found 80.9% prenatal care coverage, with six or more appointments, high performance of exams and provision of hand-held prenatal notes. However, this study is only based on interviews with women without checking the prenatal records, which is subject to more recall bias, because it includes pregnancies that occurred in the last five years. Whereas it is important that national data allow a better assessment of the care provided, the objective of this study is to analyze the prenatal care provided to pregnant women in the public and/or private health services in Brazil, considering their suitability according to some predefined parameters of the Ministry of Health 12, their organization and relationship with other services of the health system as well as the profile of the users of prenatal services.