O acesso e a utilização dos serviços de saúde materno-infantis no município de Juiz de Fora- MG

Abstract

Health inequalities come to being in many different ways in the health-disease process, be it in the form of access or the utilization of health services. Although many studies undertaken in Brazil have highlighted the existence of inequities in the utilization of health services, there are limitations in the interpretation of such approach. This study analyses the utilization of health services with focus on the actual use, while the theoretical concept of Access adopted here is the one which breaks it down into three dimensions: Availability, Affordability and Acceptability. The objectives of the study are, therefore: to describe and evaluate the utilization of and access to infant-maternal health services during three well-defined moments of the pregnancy-puerperal cycle (antenatal, birth and infant care); to investigate the significance of the potential association of such aspects with living conditions and lifestyle and to assess the influence of geographical location on the utilization of and access to health services. A sharper view of observed inequities in health services provision and utilization was enabled by means of a cross-section household sample-survey epidemiological study undertaken in the city of Juiz de Fora, state of Minas Gerais, Brazil. Results show high percentages of health services utilization: 99.5% for antenatal, 100% for hospital births and 90.3% for infant care, the great majority of which provided by the unified public sector – SUS (65.3% for antenatal, 76.6% for births and 58.4% for infant care). Factor analysis (PCA) shows that for the latent variable access, the dimensions Availability and Affordability are predominant. The geographical distributions of the scores obtained from the first factor of PCA for the three moments show persistently disadvantaged areas in terms of access. Multiple linear regression, undertaken for the antenatal moment, shows that the variables kept in the models stress the importance of socioeconomic and demographic factors in the explanation of the observed variance in access. For the Availability dimension of access the significant covariates (p<0.05) associated positively with the scores are: mother´s educational level, mother living with partner, age of partner and belonging to higher social classes. The covariates negatively asso ciated with the scores were: parity, distance to health services and male as head of household. For the Acceptability dimension the following covariates are significant and positively associated with the scores: head of household in full employment, distance to health services, mother´s education and male as head of household; the only covariate negatively associated with the scores is: number of residents in the dwelling. Notwithstanding the advances shown by the levels of utilization, the analyses based on access to health services indicate that inequalities remain. We expect the results presented can contribute to the formulation of more effective public policies targeted at the implementation of equity in terms of Access.