Sociodemographic and Regional Inequalities in Antenatal Care (ANC) in Brazil

Despite improvements in antenatal care (ANC) coverage in Brazil over the years, social inequalities persist, compromising the quality and effectiveness of the care provided to pregnant women. This study aimed to estimate the prevalence of pregnant women by adequacy of prenatal care according to sociodemographic characteristics and regions of residence.  Methods: Using data from the 2019 Brazilian National Health Survey, we analyzed 2,875 women aged 15 years or older who had given birth in the two years preceding the survey. Based on the Ministry of Health guidelines, ANC was categorized as inadequate (less than six consultations or not having started in the first trimester of pregnancy) and in three different levels of adequacy, from least to most adequate. To identify the main determinants of high-quality ANC, a multivariate logistic regression model was applied, using sociodemographic and geographic variables as predictors.   Results: Prevalence of women with inadequate ANC was 22.8%. Adequacy proportions of levels 1, 2, and 3 were 77.2, 51.8, and 42.4%, respectively. According to the results of the multivariate logistic regression model, women living in the North and Northeast regions were less likely to receive adequate ANC compared with those in the South (OR = 0.60 and OR = 0.65, 95% CI 0.39-0.93 and 0.44-0.95, respectively; p < 5%). Women living in urban areas compared with rural areas (OR = 1.64; 95% CI 1.20-2.26, p < 1%), as well as those with a partner or spouse (OR = 1.41; 95% CI 1.04-1.91, p < 5%), were significantly more likely to receive adequate ANC. Women with primary education showed less adequate ANC (OR = 0.56; 95% CI 0.35-0.88, p < 5%), as did younger women. Having been assisted by a doctor during pregnancy was significantly associated with better adequacy (OR = 1.72; 95%CI 1.29-2.29, p < 1%). The other variables (residence in the capital, race/skin color, and location of consultations) were not statistically significant.  Conclusion:  The findings emphasize the importance of monitoring the quality of ANC, especially to identify and meet the needs of the most vulnerable women during pregnancy.