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Equidade na utilização dos serviços de saúde no Brasil: um estudo comparativo entre as regiões brasileiras no período 1998-2008

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  • Mônica Viegas Andrade

    (Cedeplar/UFMG)

  • Kenya Valéria M. de Souza Noronha

    (Cedeplar/UFMG)

  • Abhishek Singh

    (International Institute for Population Studies)

  • Cristina Guimarães Rodrigues

    (FEA/USP)

  • Sabu S. Padmadas

    (University of Southampton, Highfield)

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    Abstract

    Antenatal care encompasses a broad spectrum of clinical procedures and care provided to pregnant women. Ideally, all pregnant women should have proper access to effective antenatal care irrespective of their social, economic, cultural and geographical background. This paper investigates the extent of inequalities in antenatal care and takes a step further in analysing some medical procedures followed during antenatal care in Brazil and India. Data are drawn from the 2006 Brazilian Demographic and Health Survey (DHS) and the third round of the DHS equivalent Indian National Family Health Survey (NFHS-3) conducted during 2005-06. Concentration index and concentration curves were estimated to quantify the degree of socioeconomic inequalities in antenatal care. Binary logistic regression models were used to determine the association between socioeconomic inequalities and antenatal care. The findings demonstrate evidence of wider socioeconomic inequalities in antenatal care utilisation and medical procedures in Brazil and India. Antenatal coverage is relatively much higher in Brazil and distributed uniformly across different socioeconomic groups than in India. The Indian case, however, presents problems of scale and equity in overall coverage and extent of utilisation whereas in Brazil, despite high utilisation of care, there is still considerable variation in the use of 6 or more ANC visits. The analyses suggest that Brazil overall has succeeded in reducing socioeconomic inequalities guaranteeing universal coverage to most essential antenatal services. This is different in India where antenatal utilisation is restricted mostly in southern and western geographical regions, yet the gap between the rich and the poor is substantial. The comparison between Brazil and India enabled a systematic examination of antenatal care taking into account different institutional and health policy regimes and socioeconomic background.

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    Bibliographic Info

    Paper provided by Cedeplar, Universidade Federal de Minas Gerais in its series Textos para Discussão Cedeplar-UFMG with number td446.

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    Date of creation: Aug 2011
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    Handle: RePEc:cdp:texdis:td446

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    Related research

    Keywords: Antenatal Care; Brazil; India; Socioeconomic Inequality; Health Inequalities.;

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    1. van Doorslaer, Eddy & Wagstaff, Adam, 1992. "Equity in the delivery of health care: some international comparisons," Journal of Health Economics, Elsevier, Elsevier, vol. 11(4), pages 389-411, December.
    2. Filmer, Deon & Pritchett, Lant, 1998. "Estimating wealth effects without expenditure data - or tears : with an application to educational enrollments in states of India," Policy Research Working Paper Series, The World Bank 1994, The World Bank.
    3. Jowett, Matthew, 2000. "Safe motherhood interventions in low-income countries: an economic justification and evidence of cost effectiveness," Health Policy, Elsevier, Elsevier, vol. 53(3), pages 201-228, October.
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    5. Kakwani, Nanak & Wagstaff, Adam & van Doorslaer, Eddy, 1997. "Socioeconomic inequalities in health: Measurement, computation, and statistical inference," Journal of Econometrics, Elsevier, Elsevier, vol. 77(1), pages 87-103, March.
    6. Magadi, Monica Akinyi & Madise, Nyovani Janet & Rodrigues, Roberto Nascimento, 2000. "Frequency and timing of antenatal care in Kenya: explaining the variations between women of different communities," Social Science & Medicine, Elsevier, Elsevier, vol. 51(4), pages 551-561, August.
    7. Wagstaff, Adam & Paci, Pierella & van Doorslaer, Eddy, 1991. "On the measurement of inequalities in health," Social Science & Medicine, Elsevier, Elsevier, vol. 33(5), pages 545-557, January.
    8. Wagstaff, Adam & van Doorslaer, Eddy & van der Burg, Hattem & Calonge, Samuel & Christiansen, Terkel & Citoni, Guido & Gerdtham, Ulf-G & Gerfin, Mike & Gross, Lorna & Hakinnen, Unto, 1999. "Equity in the finance of health care: some further international comparisons1," Journal of Health Economics, Elsevier, Elsevier, vol. 18(3), pages 263-290, June.
    9. Mark Montgomery & Michele Gragnolati & Kathleen Burke & Edmundo Paredes, 2000. "Measuring living standards with proxy variables," Demography, Springer, Springer, vol. 37(2), pages 155-174, May.
    10. Pallikadavath, Saseendran & Foss, Mary & Stones, R William, 2004. "Antenatal care: provision and inequality in rural north India," Social Science & Medicine, Elsevier, Elsevier, vol. 59(6), pages 1147-1158, September.
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