title: Adequacy of public maternal care services in Brazil.
abstract: BACKGROUND
  In Brazil, hospital childbirth care is available to all, but differences in access and quality of care result in inequalities of maternal health. The objective of this study is to assess the infrastructure and staffing of publicly financed labor and birth care in Brazil and its adequacy according to clinical and obstetric conditions potentially associated with obstetric emergencies.
  
  
  METHODS
  Nationwide cross-sectional hospital-based study "Birth in Brazil: national survey into labor and birth" conducted in 2011-2012. Data from 209 hospitals classified as public (public funding and management) or mixed (public or private funding and private management) that generate estimates for 1148 Brazilian hospitals. Interview with hospital managers provided data for the structure adequacy assessment covering four domains: human resources, medications, equipment for women emergency care and support services. We conducted analysis of the structure adequacy rate according to type of hospital (public or mixed), availability of ICU and the woman obstetric risk using the X2test to detect differences in categorical variables with the level of statistical significance set at p <0.05.
  
  
  RESULTS
  Global rate of adequacy of 34.8 %: 42.2 % in public hospitals and 29.0 % in mixed hospitals (p < 0.001). Public and mixed hospitals with ICU had higher scores of adequacy than hospitals without ICU (73.3 % × 24.4 % public hospitals; 40.3 % × 10.6 % mixed hospitals). At a national level, 32.8 % of women with obstetric risk were cared for in hospitals without ICU and 29.5 % of women without risk were cared for in hospitals with ICU. Inequalities were observed with the North, Northeast and non-capital regions having the lower rates of hospitals with ICU.
  
  
  CONCLUSIONS
  The majority of maternity wards across the country have a low rate of adequacy that can affect the quality of labor and birth care. This holds true for women at high obstetric risk, who suffer the possibility of having their care compromised by failures of hospital infrastructure, and for women at low obstetric risk, who may not receive the appropriate care to support the natural evolution of their labor when in a technological hospital environment.
authors: Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. bittencourtsonia@gmail.com.
authors: Sonia Duarte de Azevedo
authors: SD
authors: Bittencourt
authors: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors: Rosa Maria Soares Madeira
authors: RM
authors: Domingues
authors: Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors: Lenice Gnocchi da Costa
authors: LG
authors: Reis
authors: Subsecretaria de Vigilância, Fiscalização Sanitária e Controle de Zoonose, Secretaria Municipal de Saúde, Rio de Janeiro, Brazil.
authors: Márcia Melo
authors: MM
authors: Ramos
authors: Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors: Maria do Carmo
authors: MD
authors: Leal
mesh_terms: D001938:Brazil; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006779:Hospitals, Public / Q000592:standards*; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000592:standards*; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data*; D009774:Obstetrics / Q000706:statistics & numerical data*; D036801:Parturition; D011247:Pregnancy; D011787:Quality of Health Care
keywords: Maternal health; Maternity hospitals; Quality of health care; Structure of services