Antenatal care and caesarean sections: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982-2015

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art_BARROS_Antenatal_care_and_caesarean_sections_trends_and_inequalities_2019.PDF (773.23 KB)
Citações na Scopus
23
Tipo de produção
article
Data de publicação
2019
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
OXFORD UNIV PRESS
Autores
BARROS, Aluisio J. D.
VICTORA, Cesar G.
HORTA, Bernardo L.
WEHRMEISTER, Fernando C.
BASSANI, Diego
SILVEIRA, Mariangela F.
SANTOS, Leonardo P.
BLUMENBERG, Cauane
BARROS, Fernando C.
Citação
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY, v.48, suppl.1, p.i37-i45, 2019
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background Antenatal care and correctly indicated caesarean section can positively impact on health outcomes of the mother and newborn. Our objective was to describe how coverage and inequalities for these interventions changed from 1982 to 2015 in Pelotas, Brazil. Methods Using perinatal data from the 1982, 1993, 2004 and 2015 Pelotas birth cohorts, we assessed antenatal care coverage and caesarean section rates over time. Antenatal care indicators included the median number of visits, the prevalence of mothers attending at least six visits and the proportion who started antenatal care in the first trimester of pregnancy and attended at least six visits. We described these outcomes according to income quintiles and maternal skin colour, to identify inequalities. We described overall, private sector and public sector caesarean section rates. Differences in prevalence were tested using chi-square testing and median differences using Kruskal-Wallis testing. Results From 1982 to 2015, the median number of antenatal care visits and the prevalence of mothers attending at least six visits increased in all income quintiles and skin colour groups. Inequalities were reduced, but not eliminated. The overall proportion of caesarean births increased from 27.6% in 1982 to 65.1% in 2015, when 93.9% of the births in the private sector were by caesarean section. Absolute income-related inequalities in caesarean sections increased over time. Conclusions Special attention should be given to the antenatal care of poor and Black women in order to reduce inequalities. The explosive increase in caesarean sections requires radical changes in delivery care policies, in order to reverse the current trend.
Palavras-chave
Prenatal care, caesarean section, healthcare disparities, cohort studies
URI
https://observatorio.fm.usp.br/handle/OPI/32512
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MPR
Artigos e Materiais de Revistas Científicas - LIM/39
Artigos e Materiais de Revistas Científicas - ODS/03
Artigos e Materiais de Revistas Científicas - ODS/05
Artigos e Materiais de Revistas Científicas - ODS/10