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Open Access Research article

Inadequate prenatal care utilization and associated factors in São Luís, Brazil

Ariane Cristina Ferreira Bernardes1, Raimundo Antonio da Silva1, Liberata Campos Coimbra2, Maria Teresa Seabra Soares de Britto Alves1, Rejane Christine de Sousa Queiroz1, Rosângela Fernandes Lucena Batista1, Heloisa Bettiol3, Marco Antônio Barbieri3* and Antônio Augusto Moura da Silva1

Author Affiliations

1 Department of Public Health, Federal University of Maranhão, Brazil, Rua Barão de Itapary, 155, Centro, São Luís, Maranhão 65020-070, Brazil

2 Department of Nursing, Federal University of Maranhão, Brazil, Rua Viana Vaz, 230, Centro, São Luís, Maranhão 65020-660, Brazil

3 Department of Puericulture and Pediatrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil, Avenida Bandeirantes, 3900, Hospital das Clínicas de Ribeirão Preto, Monte Alegre, Ribeirão Preto, São Paulo 14049-900, Brazil

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BMC Pregnancy and Childbirth 2014, 14:266  doi:10.1186/1471-2393-14-266

Published: 10 August 2014



Over the last decades there has been a reduction of social inequalities in Brazil, as well as a strong expansion of health services, including prenatal care. The objective of the present study was to estimate the rate of inadequate prenatal care utilization and its associated factors in São Luís, Brazil, in 2010 and to determine whether there was a reduction of inequity in prenatal care use by comparing the present data to those obtained from a previous cohort started in 1997/98.


Data from the BRISA (Brazilian birth cohort studies of Ribeirão Preto and São Luís) population-based cohort, which started in 2010 (5067 women), were used. The outcome variable was the inadequate utilization of prenatal care, classified according to the recommendations of the Brazilian Ministry of Health. The explanatory variables were organized into three hierarchical levels based on the Andersen’s behavioral model of the use of health services: predisposing, enabling and need factors.


Only 2.0% of the women did not attend at least one prenatal care visit. The rate of inadequate prenatal care utilization was 36.7%. Despite an improved adequacy of prenatal care use from 47.3% in 1997/98 to 58.2% in 2010, social inequality persisted: both low maternal schooling (prevalence ratio (PR) = 2.78; 95% confidence interval (95% CI) 2.23-3.47 for 0 to 4 years of study) and low family income, less than 0.5 monthly minimum wage per capita (PR = 1.37; 95% CI 1.22-1. 54), continued to be associated with higher rates of inadequate prenatal care utilization. Racial disparity regarding adequate utilization of prenatal services was detected, with black (PR = 1.19; 95% CI 1.04-1.36) and mulatto (PR = 1.14; 95% CI 1.02-1.26) women showing higher rates of inadequate use. On the other hand, women covered by the FHP - Family Health Program (PR = 0.92; 95% CI 0.85-0.98) showed a lower rate of inadequate prenatal care utilization.


Despite strong expansion of health services and expressive improvements in adequate prenatal care use and social indicators, inequalities in prenatal care use still persist. The FHP seems to be effective in reducing inadequate prenatal care utilization.

Prenatal care; Maternal welfare; Delivery of health care; Health evaluation; Health status disparities; Antenatal care