# Adequacy of prenatal care in the state of Rio de Janeiro according to the type of childbirth funding

## TL;DR

Prenatal care in Rio de Janeiro is generally inadequate, especially for women with public funding, who face higher social vulnerability and poorer care quality.

## Contribution

This study evaluates prenatal care adequacy in Rio de Janeiro by childbirth funding type, revealing disparities in care quality between public and private systems.

## Key findings

- Only 1% of women achieved overall adequate prenatal care when all components were considered.
- Women with public financing had lower coverage and adequacy in prenatal care timing, consultations, tests, and counseling.
- Prenatal care inadequacy is linked to higher social vulnerability, increasing the risk of adverse outcomes.

## Abstract

To evaluate the adequacy of prenatal care (PNC) in the state of Rio de Janeiro (SRJ) according to the type of childbirth funding.

A cross-sectional, hospital-based study conducted from 2021 to 2023 through interviews with postpartum women and collection and analysis of data from prenatal cards and medical records in public and private hospitals. Overall adequacy and adequacy of various PN components were estimated based on care guidelines from the World Health Organization and the Brazilian Ministry of Health, using 95% as the standard for adequacy.

PN coverage was 98.5%, with 98.6% of women having received a prenatal card. Among the 1,325 women with an available card, 79,3% began PNC by the 12th gestational week; 75.5% had the adequate number of consultations for gestational age at delivery; 64.7% had documentation of all first routine PN tests, and 18.9% of the second; 31.6% received adequate immunization for tetanus and hepatitis B; 29.4% received iron and folic acid supplementation; and 17.6% received counseling on delivery types, reference maternity hospital, and were asked about alcohol use and smoking. A decrease in PN adequacy was observed when all components were considered, with less than 1% of women achieving overall adequacy. Women with publicly financed births had greater social vulnerability and lower PN coverage and adequacy in terms of timing, number of consultations, tests, and counseling.

PNC was found to be inadequate in SRJ, with lower adequacy among women with public financing, who represent a group with higher social vulnerability, increasing the likelihood of adverse outcomes in this population. It is essential to develop and implement strategies to improve PN adequacy and to ensure the best care for those who need it most.

Avaliar a adequação da assistência pré-natal (PN) no estado do Rio de Janeiro (ERJ) segundo o tipo de financiamento do parto.

Estudo transversal, de base hospitalar, realizado no período 2021–2023, por meio de entrevista com puérperas, coleta e análise de dados de cartão da gestante e prontuário médico em hospitais públicos e privados. Foi estimada a adequação global e dos diversos componentes da assistência PN, utilizando como critério as diretrizes assistenciais da Organização Mundial da Saúde e Ministério da Saúde brasileiro, com o parâmetro de 95% como padrão de adequação.

Cobertura PN de 98,5%, com 98,6% das mulheres tendo recebido cartão da gestante. Das 1.325 mulheres com cartão disponível, 79,3% tiveram início da assistência pré-natal até a 12ª semana gestacional; 75,5% tiveram o número adequado de consultas para a idade gestacional no parto; 64,7% tiveram o registro de todos os exames da primeira rotina de PN e 18,9% da segunda; 31,6% receberam imunização adequada para tétano e hepatite B; 29,4% receberam suplementação de sulfato ferroso e ácido fólico; e 17,6% receberam orientações sobre tipos de parto, maternidade de referência e foram questionadas sobre o uso de álcool e tabagismo. Verificou-se redução da adequação do PN ao incorporar todos os componentes, com menos de 1% das mulheres apresentando adequação global do PN. Mulheres com financiamento público apresentaram maior vulnerabilidade social e menor cobertura de PN e de adequação de época de início, número de consultas, exames e orientações.

A assistência pré-natal mostrou-se inadequada no ERJ, com menor adequação em mulheres com financiamento público, que constituem um grupo com maior vulnerabilidade social, aumentando a probabilidade de desfechos negativos nessa população. É essencial a elaboração e implantação de estratégias destinadas a aumentar a adequação do PN e oferecer o melhor cuidado justamente àquelas que mais necessitam dessas ações.