Coverage and equity in reproductive and maternal health interventions in Brazil

Impressive progress following the implementation of the Unified Health System

Giovanny V A França, María Clara Restrepo-Méndez, Maria Fátima S Maia, Cesar G. Victora, Aluísio J D Barros

Research output: Contribution to journalArticle

Abstract

Background: The Brazilian SUS (Unified Health System) was created in 1988 within the new constitution, based on the premises of being universal, comprehensive, and equitable. The SUS offers free health care, independent of contribution or affiliation. Since then, great efforts and increasing investments have been made for the system to achieve its goals. We assessed how coverage and equity in selected reproductive and maternal interventions progressed in Brazil from 1986 to 2013. Methods: We reanalysed data from four national health surveys carried out in Brazil in 1986, 1996, 2006 and 2013. We estimated coverage for six interventions [use of modern contraceptives; antenatal care (ANC) 1+ visits by any provider; ANC 4+ visits by any provider; first ANC visit during the first trimester of pregnancy; institutional delivery; and Caesarean sections] using standard international definitions, and stratified results by wealth quintile, urban or rural residence and country regions. We also calculated two inequality indicators: the slope index of inequality (SII) and the concentration index (CIX). Results: All indicators showed steady increases in coverage over time. ANC 1+ and 4+ and institutional delivery reached coverage above 90 % in 2013. Prevalence of use of modern contraceptives was 83 % in 2013, indicating nearly universal satisfaction of need for contraception. On a less positive note, the proportion of C-sections has also grown continuously, reaching 55 % in 2013. There were marked reductions in wealth inequalities for all preventive interventions. Inequalities were significantly reduced for all indicators except for the C-section rate (p = 0.06), particularly in absolute terms (SII). Conclusions: Despite the difficulties faced in the implementation of SUS, coverage of essential interventions increased and equity has improved dramatically, due in most cases to marked increase in coverage among the poorest 40 %. An increase in unnecessary Caesarean sections was also observed during the period. Further evaluation on the quality of healthcare provided is needed.

Original languageEnglish (US)
Article number149
JournalInternational Journal for Equity in Health
Volume15
Issue number1
DOIs
StatePublished - Nov 17 2016
Externally publishedYes

Fingerprint

Reproductive Health
Prenatal Care
Brazil
Health
Contraceptive Agents
Cesarean Section
Quality of Health Care
Constitution and Bylaws
First Pregnancy Trimester
Health Surveys
Contraception
Mothers
Maternal Health
Delivery of Health Care

Keywords

  • Brazil
  • Health inequalities
  • Maternal health
  • Socioeconomic factors

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Coverage and equity in reproductive and maternal health interventions in Brazil : Impressive progress following the implementation of the Unified Health System. / França, Giovanny V A; Restrepo-Méndez, María Clara; Maia, Maria Fátima S; Victora, Cesar G.; Barros, Aluísio J D.

In: International Journal for Equity in Health, Vol. 15, No. 1, 149, 17.11.2016.

Research output: Contribution to journalArticle

França, Giovanny V A ; Restrepo-Méndez, María Clara ; Maia, Maria Fátima S ; Victora, Cesar G. ; Barros, Aluísio J D. / Coverage and equity in reproductive and maternal health interventions in Brazil : Impressive progress following the implementation of the Unified Health System. In: International Journal for Equity in Health. 2016 ; Vol. 15, No. 1.
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