El cuidado prenatal y los determinantes sociales: estudio ecológico en Argentina <span class="so-article-trans-title" dir="auto"> Translated title: Prenatal care and social determinants: ecological study in Argentina </span>

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Abstract

Resumen Introducción: el cuidado prenatal es un aspecto clave de salud pública, con gran impacto en la salud materna y perinatal, así como en otras etapas del ciclo vital. Sus características pueden ser variables entre y al interior de los países, y vincularse a ciertos determinantes sociales. El objetivo de este estudio fue identificar escenarios sociosanitarios del cuidado prenatal y analizar asociaciones entre determinantes sociales e indicadores sintéticos seleccionados del cuidado prenatal en Argentina (2010-2018). Metodología: se desarrolló un estudio ecológico de grupos múltiples (n = 24 jurisdicciones). Los datos se obtuvieron a partir de fuentes secundarias: última información disponible del Sistema Informático Perinatal (2018) y censo nacional (2010). Se realizó un análisis de conglomerados de tipo jerárquico y aglomerativo (método de Ward). Se ilustró la distribución espacial de los escenarios identificados y se valoraron las diferencias entre ellos mediante la prueba ANOVA. Para estimar asociaciones entre indicadores sociales e indicadores del cuidado prenatal se propusieron modelos de regresión lineal. Resultados: se identificaron cinco escenarios sociosanitarios del cuidado prenatal, que revelan heterogeneidades en la distribución de indicadores de cuidado prenatal y sociales a nivel provincial. Además, el porcentaje de hogares en situación de pobreza presentó una asociación directa, en tanto el índice de desarrollo humano y la esperanza de vida al nacer una inversa con el control prenatal insuficiente. Conclusiones: existen diferentes escenarios sociosanitarios del cuidado prenatal en Argentina y ciertas características sociales de los contextos en que residen las personas podrían subyacer a su configuración.

Translated abstract

Abstract Introduction: the prenatal care is a key aspect in public health, with great impact in maternal and perinatal health, as well as in other stages of the life cycle. The features of the prenatal care could be variable between and within countries, and be related to social determinants. The aim of this study was to identify socio-sanitary scenarios of prenatal care, and to analyze associations between social determinants and selected synthetic indicators of prenatal care in Argentina (2010-2018). Methodology: A multi-group ecological study (n=24 jurisdictions) was developed. The data were obtained from secondary sources: the latest available data of the Perinatal Informatics' System (2018) and national census (2010). A hierarchical and agglomerative cluster analysis was carried out (Wards method). The spatial distribution of the scenarios was illustrated by a map. ANOVA test was applied to assess the differences between the identified scenarios. To estimate associations between social indicators and indicators of prenatal care, linear regression models were applied. Results: five socio-sanitary scenarios of prenatal care were identified, which reveal heterogeneities in the distribution of prenatal and social care indicators. In addition, the percentage of households living in poverty presented a direct association, and the human development index and life expectancy at birth an inverse association with insufficient prenatal care. Conclusions: different socio-sanitary scenarios exist in Argentina, and some social characteristics of the contexts in which people live might underlie its configuration.

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Most cited references 30

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Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants.

Allison Bryant, Ayaba Worjoloh, Aaron B Caughey … (2010)

Wide disparities in obstetric outcomes exist between women of different race/ethnicities. The prevalence of preterm birth, fetal growth restriction, fetal demise, maternal mortality, and inadequate receipt of prenatal care all vary by maternal race/ethnicity. These disparities have their roots in maternal health behaviors, genetics, the physical and social environments, and access to and quality of health care. Elimination of the health inequities because of sociocultural differences or access to or quality of health care will require a multidisciplinary approach. We aim to describe these obstetric disparities, with an eye toward potential etiologies, thereby improving our ability to target appropriate solutions. Copyright 2010 Mosby, Inc. All rights reserved.

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Determinants of prenatal care use: evidence from 32 low-income countries across Asia, Sub-Saharan Africa and Latin America.

Harminder Guliani, Ardeshir Sepehri, John Serieux (2014)

While much has been written on the determinants of prenatal care attendance in low-income countries, comparatively little is known about the determinants of the frequency of prenatal visits in general and whether there are separate processes generating the decisions to use prenatal care and the frequency of use. Using the Demographic and Health Surveys data for 32 low-income countries (across Asia, Sub-Saharan Africa and Latin America) and appropriate two-part and multilevel models, this article empirically assesses the influence of a wide array of observed individual-, household- and community-level characteristics on a woman's decision to use prenatal care and the frequency of that use, while controlling for unobserved community level factors. The results suggest that, though both the decision to use care and the number of prenatal visits are influenced by a range of observed individual-, household- and community-level characteristics, the influence of these determinants vary in magnitude for prenatal care attendance and the frequency of prenatal visits. Despite remarkable consistency among regions in the association of individual, household and community indicators with prenatal care utilization, the estimated coefficients of the risk factors vary greatly across the three world regions. The strong influence of household wealth, education and regional poverty on the use of prenatal care suggests that safe motherhood programmes should be linked with the objectives of social development programmes such as poverty reduction, enhancing the status of women and increasing primary and secondary school enrolment rate among girls. Finally, the finding that teenage mothers and unmarried women and those with unintended pregnancies are less likely to use prenatal care and have fewer visits suggests that safe mother programmes need to pay particular attention to the disadvantaged and vulnerable subgroups of population whose reproductive health issues are often fraught with controversy.

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Barriers, motivators and facilitators related to prenatal care utilization among inner-city women in Winnipeg, Canada: a case–control study

Maureen Heaman, Michael Moffatt, Lawrence Elliott … (2014)

Background The reasons why women do not obtain prenatal care even when it is available and accessible are complex. Despite Canada’s universally funded health care system, use of prenatal care varies widely across neighborhoods in Winnipeg, Manitoba, with the highest rates of inadequate prenatal care found in eight inner-city neighborhoods. The purpose of this study was to identify barriers, motivators and facilitators related to use of prenatal care among women living in these inner-city neighborhoods. Methods We conducted a case–control study with 202 cases (inadequate prenatal care) and 406 controls (adequate prenatal care), frequency matched 1:2 by neighborhood. Women were recruited during their postpartum hospital stay, and were interviewed using a structured questionnaire. Stratified analyses of barriers and motivators associated with inadequate prenatal care were conducted, and the Mantel-Haenszel common odds ratio (OR) was reported when the results were homogeneous across neighborhoods. Chi square analysis was used to test for differences in proportions of cases and controls reporting facilitators that would have helped them get more prenatal care. Results Of the 39 barriers assessed, 35 significantly increased the odds of inadequate prenatal care for inner-city women. Psychosocial issues that increased the likelihood of inadequate prenatal care included being under stress, having family problems, feeling depressed, “not thinking straight”, and being worried that the baby would be apprehended by the child welfare agency. Structural barriers included not knowing where to get prenatal care, having a long wait to get an appointment, and having problems with child care or transportation. Attitudinal barriers included not planning or knowing about the pregnancy, thinking of having an abortion, and believing they did not need prenatal care. Of the 10 motivators assessed, four had a protective effect, such as the desire to learn how to protect one’s health. Receiving incentives and getting help with transportation and child care would have facilitated women’s attendance at prenatal care visits. Conclusions Several psychosocial, attitudinal, economic and structural barriers increased the likelihood of inadequate prenatal care for women living in socioeconomically disadvantaged neighborhoods. Removing barriers to prenatal care and capitalizing on factors that motivate and facilitate women to seek prenatal care despite the challenges of their personal circumstances may help improve use of prenatal care by inner-city women.

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Author and article information

Journal

Journal ID (publisher-id): psm

Title: Población y Salud en Mesoamérica

Abbreviated Title: PSM

Publisher: Universidad de Costa Rica. Centro Centroamericano de Población (San Pedro, San José, San Pedro de Montes de Oca, Costa Rica )

ISSN (Electronic): 1659-0201

Publication date (Print and electronic): June 2022

Volume: 19

Issue: 2

Pages: 224-244

Affiliations

[7] Córdoba orgnameUniversidad Nacional de Córdoba Argentina geacevedo_esp@ 123456fcm.unc.edu.ar

[3] Córdoba orgnameUniversidad Nacional de Córdoba Argentina virperesini81@ 123456hotmail.com

[4] Córdoba orgnameUniversidad Nacional de Córdoba Argentina eugepeisino@ 123456hotmail.com

[2] Córdoba orgnameUniversidad Nacional de Córdoba Argentina anacgodoy@ 123456yahoo.com.ar

[1] Córdoba orgnameUniversidad Nacional de Córdoba Argentina natalia.tumas@ 123456unc.edu.ar

[6] Córdoba orgnameUniversidad Nacional de Córdoba Argentina tanovaggione@ 123456gmail.com

[5] Córdoba orgnameUniversidad Nacional de Córdoba Argentina gi_boldrini@ 123456hotmail.com

Article

Publisher ID: S1659-02012022000100224 Publisher ID: S1659-0201(22)01900200224

DOI: 10.15517/psm.v0i19.47439

SO-VID: 5a317fb5-b68b-4a88-a6ea-c87050ed8baa

License:

This work is licensed under a Creative Commons Attribution 3.0 International License.

History

Date received : 16 June 2021

Date accepted : 26 November 2021

Page count

Figures: 0, Tables: 0, Equations: 0, References: 31, Pages: 21

Product

SciELO Costa Rica

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