Equidade na utilização dos serviços de saúde no Brasil: um estudo comparativo entre as regiões brasileiras no período 1998-2008

Antenatal care encompasses a broad spectrum of clinical procedures and care provided to pregnant women. Ideally, all pregnant women should have proper access to effective antenatal care irrespective of their social, economic, cultural and geographical background. This paper investigates the extent of inequalities in antenatal care and takes a step further in analysing some medical procedures followed during antenatal care in Brazil and India. Data are drawn from the 2006 Brazilian Demographic and Health Survey (DHS) and the third round of the DHS equivalent Indian National Family Health Survey (NFHS-3) conducted during 2005-06. Concentration index and concentration curves were estimated to quantify the degree of socioeconomic inequalities in antenatal care. Binary logistic regression models were used to determine the association between socioeconomic inequalities and antenatal care. The findings demonstrate evidence of wider socioeconomic inequalities in antenatal care utilisation and medical procedures in Brazil and India. Antenatal coverage is relatively much higher in Brazil and distributed uniformly across different socioeconomic groups than in India. The Indian case, however, presents problems of scale and equity in overall coverage and extent of utilisation whereas in Brazil, despite high utilisation of care, there is still considerable variation in the use of 6 or more ANC visits. The analyses suggest that Brazil overall has succeeded in reducing socioeconomic inequalities guaranteeing universal coverage to most essential antenatal services. This is different in India where antenatal utilisation is restricted mostly in southern and western geographical regions, yet the gap between the rich and the poor is substantial. The comparison between Brazil and India enabled a systematic examination of antenatal care taking into account different institutional and health policy regimes and socioeconomic background.