[Maternal and child care in two population-based cohorts from southern Brazil: trends and differences]

Two cohort studies of mothers and children (1982 and 1993) were used to document changes in health care utilization patterns. The cohorts included all hospital deliveries in the city of Pelotas, Southern Brazil, for the two years. Some 20% of the mothers and children were visited at home at a median interval of one year later. However, there was a reduction in the percentage of mothers seeking care after the fifth month of pregnancy. The mean number of prenatal consultations increased to 7.6. Prenatal care indicators were significantly worse for low-income and high-gestational-risk women. In 1993, caesarean sections accounted for 31% of deliveries. The proportions of deliveries assisted by medical doctors increased to 88%. Low-income and high-risk mothers were less likely to have a caesarean section or to be assisted by a medical doctor. Over half of the deliveries in the highest income group were caesareans. Vaccine coverage at 12 months increased over the decade. Socioeconomic differentials were also observed. The mean number of medical consultations during the first year of life decreased to 10.5, mainly due to a drop in preventive care. Although most health care indicators improved over the course of the decade, health services are still biased towards those who least need them.