Tendência temporal das desigualdades dos cuidados no pré-natal e parto entre mulheres negras e brancas: resultados da Pesquisa Nacional de Saúde 2013 e 2019

Abstract

The objective was to analyze the temporal trend of access to prenatal care and childbirth in black and white women from 2013 to 2019. This study used data from the 2013 and 2019 National Health Survey (PNS), conducted by the IBGE, to understand the health of the Brazilian population. This study selected women aged between 18 and 50 who had become pregnant in the last two years. The prenatal care variables selected were prenatal care, number of visits, period when prenatal care began, professional responsible for the prenatal care, and physical, anthropometric and laboratory examinations. With regard to births, variables such as number of births, location, type of birth and whether it was carried out by the SUS were analyzed. With regard to race, the women were classified as black and white to investigate disparities in access to healthcare. The statistical analysis was carried out using STATA/SE® 12, taking into account the complexity of the PNS sample. Prevalence rates were calculated and differences were compared between white and black women and between the years studied, using 95% confidence intervals (95%CI) to identify significant discrepancies in access to health services. In 2013 and 2019, parity was higher among black women, with a higher percentage of 3 children among black women. In both years, prenatal care was virtually universal among white and black women, as was access to the pregnancy card. The prevalence of prenatal care in the SUS was higher among black women in 2013 (79.4%, 95%CI=75.6%;83.1% vs 53.4%,95%CI=47.0%;59.7%) and 2019 (72.6%, 95%CI=68.8%;76.4% vs 48.1%,95%CI=42.8%;53.3%, respectively). The number of prenatal consultations was higher among white women in 2013 (91.9%, 95%CI=89.1;94.7% vs 79.5%, 95%CI=75.7%;83.4%) with a reduction in inequality in 2019. In 2019, while 86.3% of white women had prenatal consultations with doctors (95% CI: 83.2%;89.4%), only 67.6% of black women did (95% CI: 64.4%;70.8%). In addition, the proportion of deliveries by caesarean section was 62.4% for white women (95% CI: 57.1%;67.7%) and 52.6% for black women (95% CI: 49.0%;56.3%). Blood pressure measurement at all appointments was lower among black women in 2019. The prevalence of normal delivery was higher among black women in 2013 and 2019. In general, we found that among black women there is greater parity, the majority of prenatal consultations and childbirth being carried out in the SUS, a higher prevalence of prenatal consultations being carried out by professional nurses and a predominance of normal childbirth and the reason for cesarean sections for tubal ligation. There was a reduction in inequality in the period analyzed between black and white women in terms of the number of prenatal consultations, breast exams during prenatal care, but an increase in inequality in terms of blood pressure measurement at all consultations.