Silva Larissa Adna Neves, Blumenberg Cauane, Barros Aluísio J D
International Center for Equity in Health and Postgraduate Program in Epidemiology Federal University of Pelotas Pelotas Brazil International Center for Equity in Health and Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
Rev Panam Salud Publica. 2025 Aug 8;49:e86. doi: 10.26633/RPSP.2025.86. eCollection 2025.
To identify groups of women in Brazil more likely to have deliveries outside health facilities and the types of professionals attending these deliveries, and to assess related social determinants.
Data from Brazil's Live Birth Information System from 2018 to 2022 were used to investigate non-institutional deliveries by region of residence, ethnicity/skin color, schooling, and maternal age at delivery. Associations between these factors were also assessed. The proportion of births attended by doctors, nurses/midwives, traditional birth attendants, and others was also analyzed, comparing institutional and non-institutional deliveries.
The overall prevalence of non-institutional deliveries was 1.0%. Higher proportions were observed in the North region (4.0%), and among Indigenous women (26.3%), adolescent mothers (1.4%), and women with fewer than 4 years of schooling (8.3%). The proportion of non-institutional deliveries was 67.6% among, Indigenous women from the North region with little education. Indigenous women with fewer than 4 years of schooling and who had a non-institutional delivery had the highest proportion of deliveries without a qualified professional (95.2%).
Cultural norms and barriers to accessing maternity services, combined with broader social inequalities and organizational challenges faced by Indigenous populations, may contribute to the high proportion of non-institutional deliveries without a skilled attendant observed among these women. Culturally sensitive strategies to expand access to maternity care for and empower Indigenous women are crucial to ensure their and their children's survival.
确定巴西更有可能在医疗机构外分娩的女性群体以及参与这些分娩的专业人员类型，并评估相关的社会决定因素。
使用巴西2018年至2022年活产信息系统的数据，按居住地区、种族/肤色、受教育程度和分娩时的产妇年龄调查非机构分娩情况。还评估了这些因素之间的关联。分析了医生、护士/助产士、传统助产士和其他人员接生的分娩比例，并对机构分娩和非机构分娩进行了比较。
非机构分娩的总体患病率为1.0%。北部地区（4.0%）、土著妇女（26.3%）、青少年母亲（1.4%）以及受教育年限少于4年的妇女（8.3%）中的比例较高。北部地区受教育程度低的土著妇女中非机构分娩的比例为67.6%。受教育年限少于4年且进行非机构分娩的土著妇女中，没有合格专业人员接生的分娩比例最高（95.2%）。
文化规范和获得孕产妇服务的障碍，再加上土著人口面临的更广泛的社会不平等和组织挑战，可能导致在这些妇女中观察到的无熟练护理人员的非机构分娩比例较高。采取对文化敏感的战略，扩大土著妇女获得孕产妇护理的机会并增强她们的权能，对于确保她们及其子女的生存至关重要。
