title: Prenatal care and childbirth assistance in Amazonian women before and after the Pacific Highway Construction (2003-2011): a cross-sectional study.
abstract: Attention to prenatal care and child delivery is important for the health of women and children, but in the Amazon these indicators tend to be historically unfavorable, in part by geographical and political isolation. In 2003 both Brazilian and Peru governments have finished paving an international road connecting remotes areas in the Brazilian Amazon to the Pacific coast in Peru.
  
  
  
  The situation of prenatal care and child delivery with mothers of children under 5 years old living in the urban area of Assis Brasil, Acre was assessed in two cross-sectional studies performed in 2003 and 2011, corresponding to the period before and after the Pacific highway construction.
  
  
  
  In 2003, most mothers were of black/Afro-American ethnicity, or "pardos" (the offspring of a Caucasian with a African descendant) (77.69 %), had more than 4 years of schooling (73.40 %) and had a mean age of 22.18 years. In 2011, the number of as a migration of indigenous women increased from 0 to 14.40 % of the respondents, because of migration from communities along the rivers to urban areas, with no other significant changes in maternal characteristics. No significant improvement in childbirth assistance was noticed between 1997 and 2011; only the percentage of in-hospital vaginal deliveries performed by doctors increased from 17.89 to 66.26 % (p <0.001) during this period. Access to prenatal care was associated with white ethnicity in 2003, and higher socioeconomic level and white ethnicity in 2011, while the higher number of prenatal visits was associated with higher maternal education and higher socioeconomic levels in 2011. Vaginal child delivery at a hospital facility was associated with maternal age in 2003, and year of birth, being of white ethnicity and higher level of education in 2011.
  
  
  
  The indicators of prenatal care and child delivery were below the national average, showing that geographical isolation still affects women's health care in the Amazon, despite the construction of the highway and governmental health protocols adopted during this period.
authors.affiliation: Centro de Ciências da Saúde e do Desporto, Universidade Federal do Acre, Campus Universitário, BR 364, Km 04, Bairro Distrito Industrial, Rio Branco, AC, Brazil.
authors.forename: Andréia S
authors.initials: AS
authors.lastname: Guimarães
authors.affiliation: Centro de Ciências da Saúde e do Desporto, Universidade Federal do Acre, Campus Universitário, BR 364, Km 04, Bairro Distrito Industrial, Rio Branco, AC, Brazil.
authors.forename: Saulo A S
authors.initials: SAS
authors.lastname: Mantovani
authors.affiliation: Centro de Ciências da Saúde e do Desporto, Universidade Federal do Acre, Campus Universitário, BR 364, Km 04, Bairro Distrito Industrial, Rio Branco, AC, Brazil.
authors.forename: Humberto
authors.initials: H
authors.lastname: Oliart-Guzmán
authors.affiliation: Centro de Ciências da Saúde e do Desporto, Universidade Federal do Acre, Campus Universitário, BR 364, Km 04, Bairro Distrito Industrial, Rio Branco, AC, Brazil.
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Martins
authors.affiliation: Centro de Ciências da Saúde e do Desporto, Universidade Federal do Acre, Campus Universitário, BR 364, Km 04, Bairro Distrito Industrial, Rio Branco, AC, Brazil.
authors.forename: José Alcântara
authors.initials: JA
authors.lastname: Filgueira-Júnior
authors.affiliation: Centro de Ciências da Saúde e do Desporto, Universidade Federal do Acre, Campus Universitário, BR 364, Km 04, Bairro Distrito Industrial, Rio Branco, AC, Brazil.
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Santos
authors.affiliation: Centro de Ciências da Saúde e do Desporto, Universidade Federal do Acre, Campus Universitário, BR 364, Km 04, Bairro Distrito Industrial, Rio Branco, AC, Brazil.
authors.forename: Athos Muniz
authors.initials: AM
authors.lastname: Braña
authors.affiliation: Centro de Ciências da Saúde e do Desporto, Universidade Federal do Acre, Campus Universitário, BR 364, Km 04, Bairro Distrito Industrial, Rio Branco, AC, Brazil.
authors.forename: Fernando Luís Cunha Castelo
authors.initials: FLCC
authors.lastname: Branco
authors.affiliation: Centro de Ciências da Saúde e do Desporto, Universidade Federal do Acre, Campus Universitário, BR 364, Km 04, Bairro Distrito Industrial, Rio Branco, AC, Brazil.
authors.forename: Thasciany Moraes
authors.initials: TM
authors.lastname: Pereira
authors.affiliation: Centro de Ciências da Saúde e do Desporto, Universidade Federal do Acre, Campus Universitário, BR 364, Km 04, Bairro Distrito Industrial, Rio Branco, AC, Brazil.
authors.forename: Breno Matos
authors.initials: BM
authors.lastname: Delfino
authors.affiliation: Centro de Ciências da Saúde e do Desporto, Universidade Federal do Acre, Campus Universitário, BR 364, Km 04, Bairro Distrito Industrial, Rio Branco, AC, Brazil.
authors.forename: Alanderson A
authors.initials: AA
authors.lastname: Ramalho
authors.affiliation: Centro de Ciências da Saúde e do Desporto, Universidade Federal do Acre, Campus Universitário, BR 364, Km 04, Bairro Distrito Industrial, Rio Branco, AC, Brazil.
authors.forename: Cristieli S M
authors.initials: CSM
authors.lastname: Oliveira
authors.affiliation: Centro de Ciências da Saúde e do Desporto, Universidade Federal do Acre, Campus Universitário, BR 364, Km 04, Bairro Distrito Industrial, Rio Branco, AC, Brazil.
authors.forename: Thiago S
authors.initials: TS
authors.lastname: Araújo
authors.affiliation: Dirección Regional de Salud de Madre de Dios, Av. Ernesto Rivero N° 475, Puerto Maldonado, Peru.
authors.forename: Carlos Hermogenes Manrique
authors.initials: CHM
authors.lastname: de Lara Estrada
authors.affiliation: Instituto Nacional de Salud, Cápac Yupanqui, Jesus María, Lima 11, 1400, Peru.
authors.forename: Nancy
authors.initials: N
authors.lastname: Arróspide
authors.affiliation: Centro de Ciências da Saúde e do Desporto, Universidade Federal do Acre, Campus Universitário, BR 364, Km 04, Bairro Distrito Industrial, Rio Branco, AC, Brazil.
authors.forename: Pascoal T
authors.initials: PT
authors.lastname: Muniz
authors.affiliation: Programa de Computação Cientifica, Fundação Osvaldo Cruz, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil.
authors.forename: Cláudia T
authors.initials: CT
authors.lastname: Codeço
authors.affiliation: Centro de Ciências da Saúde e do Desporto, Universidade Federal do Acre, Campus Universitário, BR 364, Km 04, Bairro Distrito Industrial, Rio Branco, AC, Brazil. msnunes1@yahoo.com.br.
authors.forename: Mônica
authors.initials: M
authors.lastname: da Silva-Nunes
mesh_terms: D000328:Adult; D001938:Brazil; D060389:Construction Industry; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000592:standards* / Q000639:trends; D006801:Humans; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*
keywords: Amazon; Childbirth; Prenatal care