Women's perspective in the evaluation of the Program for the Humanization of Antenatal Care and Childbirth.
OBJECTIVE
To analyze the importance of inclusion, from women's perspective, in the evaluation of the Program for the Humanization of Antenatal Care and Childbirth, carried out by the Brazilian Ministry of Health.


METHODS
This qualitative study was based on primary data collected in 2003 in an evaluation of the Program conducted in seven towns spread out among Brazil's five geographic regions. These sites were selected from a Federal Government data base utilized for quantitative analysis. Women attended by the Program were considered key informants when primary data was collected. Sixteen focal groups were performed in the primary care units. The Collective Subject Speech (CSS) method was used for qualitative analysis. The theoretical concepts of accessibility and Paideia Health within the framework of public health were used to interpret the findings.


RESULTS
The Program standardizes procedures to be taken in antenatal care and childbirth for all health services in the country, including the flow among these services. However, analysis of women's discourse in the focal groups elucidated the existence of dissonances between their needs and desires and many of the program's recommendations. Pregnant women thus choose among available services and professionals and try to set up their own schedules which, in turn, do not correspond to those set up by the program. This discrepancy damages the bond women establish with the health services and creates obstacles for the control of the activities actually provided by the health services to the women.


CONCLUSIONS
Analysis of the Program based on women's perspective identified aspects that might result in more humanized and effective antenatal care, if they are taken into account in the redefinition or correction of the Program schedule Miolo abstract Miolo abstract Miolo abstract.
Almeida
Cristiane Andréa Locatelli de
CA
Programa de Pós-Graduação em Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil.
Tanaka
Oswaldo Yoshimi
OY
D001938:Brazil; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D009313:National Health Programs / Q000592:standards*; D036801:Parturition; D017060:Patient Satisfaction; D049590:Postpartum Period / Q000523:psychology; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards*; D015397:Program Evaluation; D036301:Qualitative Research