New study points to inequalities in access to hospital births in Brazil

Published in the journal The Lancet Regional Health - Americas, an article by researchers from the Center for Technological Development in Health (CDTS/Fiocruz) points out that 1 in 4 women (25.4%) had to leave the municipality to give birth in hospitals belonging to the Unified Health System (SUS), increasing from 23.6% to 27.3% in the period analyzed. Travel distance and time also increased by 31.1% (54.0 km to 70.8 km) and 33.6% (63.1 min to 84.3 min), respectively.

The survey, which mapped more than 6.9 million births between 2010-2011 and 2018-2019, reinforces the existence of inequalities in access to hospital births in Brazil and suggests that geographical access can negatively influence health outcomes.

Entitled Geographic accessibility to hospital childbirths in Brazil (2010-2011 and 2018-2019): a cross-sectional study, the text highlights that the issue is most serious in the North and Northeast, where pregnant women travel the greatest distances (between 57km and 133 km) and face the most access difficulties (between 54 and 355 min). The study's coordinator, Bruna Fonseca, highlights the presence of these different realities between the country's regions. "For comparison's sake, in the South-East and South of Brazil, these travels are usually much shorter: they can vary between 37 km and 56 km, lasting between 38 minutes and a maximum of 52 minutes," he adds.

The researcher also explains the challenges of promoting adequate access to a regionalized obstetric network. "Although some policies seek to reduce travel distance, they do not set specific benchmarks for what is actually acceptable distance and time to give birth," he says. "Current regulations stipulate a rate of 0.28 obstetric beds for every 1,000 inhabitants dependent on the SUS, but there are many regional differences – both in age, fertility rates, and hospital or home birth practices. It is important that policies take into account the heterogeneity of the territories within Brazil."

The study also found that women who faced maternal and/or neonatal death traveled longer distances and took longer to give birth in the SUS. While women with normal birth outcomes traveled 74.9 km/85.0 min, they traveled 94.0 km/100.9 min in the last biennium analyzed (2018-2019) by the survey. "This suggests that distance and travel time may be potential risk factors for mothers

and newborns, but there are other factors to consider, such as the health status of the pregnant woman, hospital infrastructure, or access to prenatal care. [...] In future analyses, the use of multivariate techniques is essential to better understand how different factors, in addition to time and distance, contribute to adverse maternal and neonatal outcomes," says the scientist.

The time interval analyzed sought to represent two distinct phases of maternal and child care, as defined by Ordinance No. 1,459/2011 of the Ministry of Health (MS), which established the Stork Network [Rede Cegonha]. "The Stork Network aimed to improve access and quality of care for pregnant women and babies. That is why we wanted to monitor the changes that could come with this policy over time," explained Fonseca.

With the participation of the Federal University of Rio de Janeiro (UFRJ) and the Federal Rural University of Rio de Janeiro (UFRRJ), the survey used national aggregate data from the SUS Hospital Information System (SIH) and the scientists estimated travel flows, distances, and times between the women's cities of residence and the hospitals.