Factors associated with the involuntary pilgrimage for childbirth care in São Luís (Maranhão State) and Ribeirão Preto (São Paulo State), Brazil: a contribution from the BRISA cohort

• Published in: Cadernos de saúde pública 2018-11, Vol.34 (11), p.e00151217-e00151217
• Main Authors: Moraes, Lílian Machado Vilarinho de, Simões, Vanda Maria Ferreira, Carvalho, Carolina de Abreu, Batista, Rosângela Fernandes Lucena, Alves, Maria Teresa Seabra Soares de Britto E, Thomaz, Érika Bárbara Abreu Fonseca, Barbieri, Marco Antônio, Alves, Claudia Maria Coelho
• Format: Article
• Language: Portuguese
• Subjects: Adult; Birthing Centers - statistics & numerical data; Brazil; Epidemiologic Methods; Female; Health Services Accessibility - statistics & numerical data; Healthcare Disparities - statistics & numerical data; Hospitals, Maternity - statistics & numerical data; Humans; Midwifery; Residence Characteristics; Socioeconomic Factors; Young Adult
• ISSN: 1678-4464
• DOI: 10.1590/0102-311X00151217

The objectives of this study were to estimate the involuntary pilgrimage by women in labor in search of childbirth care and to identify factors associated with this endeavor in two Brazilian cities. This was a cross-sectional study nested in the BRISA birth cohort, whose sample consisted of 10,475 women admitted to the selected maternity hospitals for delivery in São Luís (Maranhão State) and Ribeirão Preto (São Paulo State). Interviews were held with questionnaires that contained sociodemographic and obstetric variables. Hierarchical modeling was used, and relative risk was calculated with Poisson regression. Involuntary pilgrimage during labor was more frequent in São Luís (35.8%) than in Ribeirão Preto (5.8%). In São Luís, factors associated with pilgrimage were: first pregnancy (RR = 1.19; 95%CI: 1.08-1.31) and schooling less than 12 complete years. However, age 35 years or older (RR = 0.65; 95%CI: 0.54-0.84) was associated with less pilgrimage. In Ribeirão Preto, such trekking for obstetric care was more frequent in women with high-risk pregnancies (RR = 2.45; 95%CI: 1.81-3.32) and those with gestational age less than 37 weeks (RR = 1.93; 95%CI: 1.50-2.50). Meanwhile, delivery with gestational age equal to or greater than 42 weeks was associated with less pilgrimage (RR = 0.57; 95%CI: 0.33-0.98). In both cities, poor women had to trek more in search of childbirth care and had no guarantee of care, even for those who had received prenatal care. The study revealed the lack of guarantee of universal and equitable access and highlighted the unequal access to childbirth care between Brazil's major geographic regions.