title: Socio-economic and ethnic group inequities in antenatal care quality in the public and private sector in Brazil.
abstract: BACKGROUND
  Socio-economic inequalities in maternal and child health are ubiquitous, but limited information is available on how much the quality of care varies according to wealth or ethnicity in low- and middle-income countries. Also, little information exists on quality differences between public and private providers.
  
  
  METHODS
  Quality of care for women giving birth in 2004 in Pelotas, Brazil, was assessed by measuring how many of 11 procedures recommended by the Ministry of Health were performed. Information on family income, self-assessed skin colour, parity and type of provider were collected.
  
  
  RESULTS
  Antenatal care was used by 98% of the 4244 women studied (mean number of visits 8.3), but the number of consultations was higher among better-off and white women, who were also more likely to start antenatal care in the first trimester. The quality of antenatal care score ranged from 0 to 11, with an overall mean of 8.3 (SD 1.7). Mean scores were 8.9 (SD 1.5) in the wealthiest and 7.9 (SD 1.8) in the poorest quintiles (P < 0.001), 8.4 (SD 1.6) in white and 8.1 (SD 1.9) in black women (P < 0.001). Adjusted analyses showed that these differences seemed to be due to attendance patterns rather than discrimination. Mean quality scores were higher in the private 9.3 (SD 1.3) than in the public sector 8.1 (SD 1.6) (P < 0.001); these differences were not explained by maternal characteristics or by attendance patterns.
  
  
  CONCLUSIONS
  Special efforts must be made to improve quality of care in the public sector. Poor and black women should be actively encouraged to start antenatal care early in pregnancy so that they can fully benefit from it. There is a need for regular monitoring of antenatal attendances and quality of care with an equity lens, in order to assess how different social groups are benefiting from progress in health care.
authors.affiliation: Rua Marechal Deodoro, Pelotas, RS, Brazil.
authors.forename: C G
authors.initials: CG
authors.lastname: Victora
authors.forename: A
authors.initials: A
authors.lastname: Matijasevich
authors.forename: Mf
authors.initials: M
authors.lastname: Silveira
authors.forename: Is
authors.initials: I
authors.lastname: Santos
authors.forename: A J D
authors.initials: AJ
authors.lastname: Barros
authors.forename: F C
authors.initials: FC
authors.lastname: Barros
mesh_terms: D044383:Black People / Q000706:statistics & numerical data*; D001938:Brazil; D015331:Cohort Studies; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards* / Q000706:statistics & numerical data; D017149:Private Sector / Q000706:statistics & numerical data; D017150:Public Sector / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D019472:Universal Health Insurance; D044465:White People / Q000706:statistics & numerical data*