Infant mortality and geographic access to childbirth in Brazilian municipalities.
OBJECTIVE
To analyze geographic access to hospital childbirth in Brazilian municipalities.


METHODS
Information on deaths and births were analyzed in regards to appropriateness for calculating the infant mortality rate during the period 2005 to 2007, for the 5,564 Brazilian municipalities. Indicators of supply and geographic access to health services were calculated to express hospital childbirth access. A multivariate regression model was used to test the association between geographic access to childbirth and the infant mortality rate in municipalities with adequate vital information.


RESULTS
Of the municipalities analyzed, 56% had adequate vital information, corresponding to 72% of Brazil's population. The geographic distance between the municipality of residence and municipality of hospitalization was inversely associated to population size, per capita income and the infant mortality rate, even when controlling for demographic and socioeconomic factors.


CONCLUSIONS
Although important strategies have been developed in Brazil to improve the quality of care for pregnant women, actions to guarantee equal access to childbirth services are still insufficient. Large geographic distance to childbirth facility was identified as a risk factor for infant mortality, together with unequal supply of quality health services and lack of integration with primary care.
Laboratório de Informações em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil. walmeida@icict.fiocruz.br
Wanessa da Silva de
Wda S
Almeida
Célia Landmann
CL
Szwarcwald
D001938:Brazil / Q000453:epidemiology; D005260:Female; D005843:Geography; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D015999:Multivariate Analysis; D036801:Parturition; D011247:Pregnancy; D011320:Primary Health Care / Q000706:statistics & numerical data; D012044:Regression Analysis; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D015996:Survival Rate