Almeida Solange Duarte de Mattos, Barros Marilisa Berti de Azevedo
Prefeitura Municipal de Campinas, Secretaria Municipal de Saúde, Campinas (SP), Brazil.
Rev Panam Salud Publica. 2005 Jan;17(1):15-25. doi: 10.1590/s1020-49892005000100003.
To compare the health care received during pregnancy, delivery, and the puerperium by women belonging to two different per capita family income strata: less than 1 minimum wage, and 1 or more minimum wages.
This is a cross-sectional observational study that was carried out with a random sample of 248 female residents of the city of Campinas, in the state of São Paulo, Brasil, who had given birth between April 2001 and March 2002. Sociodemographic data, as well as information concerning maternal morbidity and health care during pregnancy, delivery, and the puerperium, were obtained through home interviews. The Kessner index, the Adequacy of Prenatal Care Utilization index, and an index proposed by the authors based on the recommendations of the Brazilian Department of Health were used to assess the adequacy of prenatal care. The minimum wage in Brazil at the time of the study was 180 reais (approximately 71.4 USD).
The lower income group included a larger proportion of women with low schooling, as well as adolescents, black women, and single women. Prenatal care was provided by the public Unified Health System to 73.7% of the women in the lower income group, versus 33.3% in the higher income group. The women in the lower income group started attending prenatal care later and had fewer visits in all than higher-income women. However, some health care quality indicators, such as performance of routine laboratory tests and anti-HIV antibody testing, the proportion of cesarean sections, and the frequency of infant rooming-in, showed more favorable figures in the lower income group. Both groups received comparable counseling and had similar rates of clinical testing, post-delivery tubal sterilization, low birthweight children, and premature delivery. Although a significantly higher number of women in the higher income group received optimal prenatal care, the percentage of cases of inadequate care in the lower-income group was still relatively low. The frequency of health problems during pregnancy did not differ significantly between groups, except for anemia and vaginal hemorrhage, which were more frequent among women in the lower-income group (P < 0.001 and P = 0.033, respectively).
Despite marked socio-demographic differences between women in the two income categories, resulting in different living conditions, there were no significant differences between groups in terms of health problems during pregnancy or the quality of the prenatal care received. These results suggest that the organization of public health services in Campinas has succeeded in promoting equity in health care, at least to a certain extent.
比较两个不同人均家庭收入阶层的女性在孕期、分娩期及产褥期所接受的医疗保健情况，这两个阶层分别为：低于1个最低工资标准，以及1个或更多最低工资标准。
这是一项横断面观察性研究，对巴西圣保罗州坎皮纳斯市248名在2001年4月至2002年3月期间分娩的女性居民进行了随机抽样。通过家庭访谈获取社会人口统计学数据，以及有关孕产妇发病率和孕期、分娩期及产褥期医疗保健的信息。采用凯斯纳指数、产前保健利用充分性指数，以及作者根据巴西卫生部的建议提出的一个指数来评估产前保健的充分性。研究期间巴西的最低工资为180雷亚尔（约合71.4美元）。
低收入组中受教育程度低的女性、青少年、黑人女性及单身女性所占比例更大。公共统一卫生系统为73.7%的低收入组女性提供了产前保健，而在高收入组这一比例为33.3%。低收入组女性开始接受产前保健的时间较晚，且总的就诊次数少于高收入女性。然而，一些医疗保健质量指标，如常规实验室检查和抗HIV抗体检测的执行情况、剖宫产比例以及母婴同室频率，在低收入组呈现出更有利的数据。两组接受的咨询服务相当，临床检查、产后输卵管绝育、低体重儿及早产的发生率也相似。尽管高收入组中接受最佳产前保健的女性数量显著更多，但低收入组中保健不足病例的百分比仍然相对较低。除贫血和阴道出血在低收入组女性中更常见外（分别为P < 0.001和P = 0.033），两组孕期健康问题的发生率无显著差异。
尽管这两个收入类别的女性在社会人口统计学方面存在显著差异，导致生活条件不同，但两组在孕期健康问题或所接受的产前保健质量方面并无显著差异。这些结果表明，坎皮纳斯市的公共卫生服务组织至少在一定程度上成功促进了医疗保健的公平性。
