Sociodemographic inequalities and maternity care of puerperae in Southeastern Brazil, according to skin color: data from the Birth in Brazil national survey (2011-2012)

Abstract

Historically, in Brazil, the health indicators of mothers and babies by skin color show an unfavorable picture to black and brown-skinned women. In the last decade, the reduction of disparities in income and education, as well as the universalization of health care, may have altered this situation to some extent. The objective of this study was to analyze the changes in socio-demographic inequalities and maternity care in Southeastern Brazil, by race/color, in the last decade. We used data from the national survey Born in Brazil (2011-2012). Descriptive statistical analysis was performed in order to define socio-demographic characteristics, access to antenatal care, clinical and obstetric history, and characteristics of birth assistance. We found differences unfavorable to black and brown-skinned women in education, income, and paid work; white women had more private health insurance plans, and increased age. Black and brown women had fewer medical appointments, fewer ultrasounds, more antenatal care considered inadequate, higher parity, and more hypertensive disorders. In childbirth, they had fewer companions and more vaginal deliveries, although the cesarean rate has grown twice as high among black women. More often they went into labor and had children born full term. There was no statistically significant difference in marital status, pregnancy complications, diabetes mellitus, anemia, syphilis, HIV, pilgrimage to delivery, neonatal or maternal near miss, and most of the interventions in vaginal delivery. Although major disparities persist, there was some reduction in sociodemographic differences as well as increased access to both appropriate and unnecessary and potentially harmful interventions.