title: The use of maternal and child health services in three population-based cohorts in Southern Brazil, 1982-2004.
abstract: This study aimed to describe indicators of health care assistance during antenatal care, delivery and in the first year of life in Pelotas, Rio Grande do Sul State, Brazil. In 1982, 1993, and 2004, all hospital newborns from the urban area of Pelotas were enrolled in a cohort study. In this period, the number of pregnant women that did not attend antenatal care fell from 4.9% to 1.9%; the mean number of appointments increased from 6.7 to 8.1; and the number of women who began antenatal care in the third trimester of pregnancy decreased from 14.8% to 7%; caesarean sections increased from 27.7% to 45.2% and the proportion of deliveries assisted by physicians increased from 61.2% to 89.2%. Improvements in immunization rates during the first year of life mainly occurred between 1982 and 1993, while the number of preventive medical appointments improved among those born in 2004. This increase in coverage was greater for low-income mothers and children, which may reflect the implementation of universal coverage in Brazil; however, coverage levels in 1982 were already high for wealthy mothers and children, reducing the scope for further gains.
authors.affiliation: Departamento Materno-Infantil, Universidade Federal do Rio Grande, Rio Grande, Brasil. jacesar@terra.com.br
authors.forename: Juraci A
authors.initials: JA
authors.lastname: Cesar
authors.forename: Alicia
authors.initials: A
authors.lastname: Matijasevich
authors.forename: Iná S
authors.initials: IS
authors.lastname: Santos
authors.forename: Aluísio J D
authors.initials: AJ
authors.lastname: Barros
authors.forename: Juvenal S
authors.initials: JS
authors.lastname: Dias-da-Costa
authors.forename: Fernando C
authors.initials: FC
authors.lastname: Barros
authors.forename: Cesar G
authors.initials: CG
authors.lastname: Victora
mesh_terms: D000704:Analysis of Variance; D001938:Brazil; D002585:Cesarean Section / Q000706:statistics & numerical data; D002648:Child; D002669:Child Welfare / Q000706:statistics & numerical data; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005191:Family Characteristics; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data; D007182:Income; D007223:Infant; D007231:Infant, Newborn; D008429:Maternal Welfare; D008430:Maternal-Child Health Centers / Q000706:statistics & numerical data*; D011247:Pregnancy; D011264:Pregnancy Trimesters; D011295:Prenatal Care / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D014612:Vaccines / Q000600:supply & distribution
chemical_list: D014612:Vaccines