Prenatal care in women using the Brazilian national health system (SUS) in two maternity hospitals in the state of Rio de Janeiro, Brazil: Does color matter?

Abstract

Objectives: To identify factors associated with inadequate prenatal care, with a special focus on skin color, among female users of the SUS in the State of Rio de Janeiro (RJ), in the final trimester of 2011. Methods: a cross-sectional cohort study was carried out at two public maternity hospitals in RJ. Interviews were conducted with 1790 women bearing children, in order of sequence. The number of consults and the date on which accompaniment of the women commenced were gathered from prenatal cards. The outcome was adequate prenatal care, classified according to the Adequate Use of Prenatal Care Index. The main factor associated with exposure was skin color, along with other socio-demographic and reproductive co-variables. Multivariate logistic regression used hierarchical levels: the variables predisposing women to the use of prenatal care were on the first and second levels, respectively. Results: dark skin color remained associated with inadequate prenatal care, even after adjustment for co-variables (OR=1.37; CI95%:1.02-1.83). Teenage pregnancy (OR=1.85; CI95%:1.43-2.41); absence of a partner (OR=1.75; CI95%:1.38-2.20) and multiparity (OR=2.40; CI95%:1.49-3.85) were also positively associated with the outcome. Prenatal care in public services (OR=0.67; CI95%: 0.49-0.91) and primiparity (OR=0.41; CI95%: 0.32 and 0.52) were protective factors. Conclusions: pregnant women who were black stood a greater chance of receiving inadequate prenatal care in RJ. Policies are needed to reduce inequalities relating to color/race in the prenatal care of this population.