Migration process of Venezuelan women to Brazil: living conditions and use of health services in Manaus and Boa Vista, 2018-2021.

BACKGROUND: The last decade saw the emergence of a new significant migration corridor due to the mass migration of Venezuelans to neighboring countries in South America. Since 2018, Brazil became the third host country of Venezuelan displaced populations. Little is known about how migratory processes affect needs, access to social programs, and public health services of migrant women. The goal of this study is to shed light on the socio-economic profile, living conditions, and use of health services of Venezuelan migrant women in two main reception cities in Brazil. METHODS: A survey was conducted using respondent-driven sampling (RDS) in the cities of Boa Vista (Roraima), and Manaus (Amazonas). The study included 2012 Venezuelan migrant women aged between 15 and 49 years old who migrated from Venezuela to Brazil between 2018 and 2021. Relative prevalence was calculated, and the χ2 test was used to analyse the homogeneity of proportions. All analyses considered the complex sampling. RESULTS: The main reasons for migrating relate to difficulties obtaining food (54%) and accessing health services (37.8%) in their country of origin. They were young and mixed race (65.7%) and had high school education (69.9%). In Manaus, 3.7% of the interviewees declared that they had no family income in the last month, while in Boa Vista, it was higher (66.2%) (p-value < 0.001). Almost one-third of them sought health care in the last 15 days, and 95% of them received care. The residents of Boa Vista arrived more recently and family income and access to paid work improved with time of residence in Brazil. CONCLUSIONS: Given the increasing flow of Venezuelan migrants crossing to Brazil, a reception system was established for the provision of food, shelter, access to health services, and income transfer programs to migrants. This was the case despite high unemployment and poverty levels and income inequality, particularly in the city of Boa Vista. However, the majority had legal migrant status and had access to the public and universal healthcare system in Brazil (SUS). The use of the SUS was similar in both cities, acting as a buffer for the differences in opportunities offered.

Reduction of inequities of access to appropriate childbirth care in Rede Cegonha. / Redução das iniquidades sociais no acesso às tecnologias apropriadas ao parto na Rede Cegonha.

This article compares the findings of "Avaliação da Rede Cegonha" (ARC - Stork Network Assessment), an evaluative study on the Rede Cegonha (RC - Stork Network) program, with Nascer no Brasil (NB - Born in Brazil), a national survey on labor and birth, conducted in 2011-12, before the start implementation of RC. ARC was conducted in 2017, in 606 maternity hospitals involved in RC and NB included a sample with national representation of 266 hospitals. In the current analysis, we included the 136 SUS hospitals that participated in both studies, totaling 3,790 and 12,227 puerperal women. We perform comparisons of best practices and interventions in the management of labor and delivery using Pearson's chi-square test for independent samples. The prevalence of best practices was, on average, 150% higher in ARC than in NB, with a greater relative increase in less developed regions, for older, brown and black women and less educated. Regarding interventions, there was an average reduction of 30% between NB and ARC, with a greater relative reduction in less developed regions and less educated women. There was a significant improvement in the scenario of care for labor and childbirth, with a reduction in regional, educational and racial inequalities in access to appropriate technologies, suggesting that the RC intervention was effective.

Este artigo compara os achados da Avaliação da Rede Cegonha (ARC), estudo avaliativo sobre o programa Rede Cegonha (RC), com o Nascer no Brasil (NB), inquérito nacional sobre parto e nascimento, realizado em 2011-12, antes do início da implementação da RC. A ARC foi conduzida em 2017, em 606 maternidades envolvidas na RC e o NB e empregou uma amostra com representatividade nacional de 266 hospitais. Na análise atual, incluímos os 136 hospitais do SUS que participaram de ambos os estudos, totalizando 3.790 e 12.227 puérperas, respectivamente. Realizamos as comparações de boas práticas e intervenções no manejo do trabalho de parto e de parto utilizando o teste qui-quadrado para amostras independentes. A prevalência das boas práticas foi, em média, 150% maior na ARC que no NB, com maior aumento relativo nas regiões menos desenvolvidas, para mulheres mais velhas, pardas e pretas e menos escolarizadas. Com relação às intervenções, houve redução média de 30% entre o NB e a ARC, com maior redução relativa nas regiões menos desenvolvidas e nas mulheres menos escolarizadas. Houve melhoria significativa no cenário da atenção ao trabalho de parto e parto, com diminuição de iniquidades regionais, de nível de instrução e raciais no acesso às tecnologias apropriadas, sugerindo que a intervenção da RC foi efetiva.

Redução das iniquidades sociais no acesso às tecnologias apropriadas ao parto na Rede Cegonha / Reduction of inequities of access to appropriate childbirth care in Rede Cegonha

Resumo Este artigo compara os achados da Avaliação da Rede Cegonha (ARC), estudo avaliativo sobre o programa Rede Cegonha (RC), com o Nascer no Brasil (NB), inquérito nacional sobre parto e nascimento, realizado em 2011-12, antes do início da implementação da RC. A ARC foi conduzida em 2017, em 606 maternidades envolvidas na RC e o NB e empregou uma amostra com representatividade nacional de 266 hospitais. Na análise atual, incluímos os 136 hospitais do SUS que participaram de ambos os estudos, totalizando 3.790 e 12.227 puérperas, respectivamente. Realizamos as comparações de boas práticas e intervenções no manejo do trabalho de parto e de parto utilizando o teste qui-quadrado para amostras independentes. A prevalência das boas práticas foi, em média, 150% maior na ARC que no NB, com maior aumento relativo nas regiões menos desenvolvidas, para mulheres mais velhas, pardas e pretas e menos escolarizadas. Com relação às intervenções, houve redução média de 30% entre o NB e a ARC, com maior redução relativa nas regiões menos desenvolvidas e nas mulheres menos escolarizadas. Houve melhoria significativa no cenário da atenção ao trabalho de parto e parto, com diminuição de iniquidades regionais, de nível de instrução e raciais no acesso às tecnologias apropriadas, sugerindo que a intervenção da RC foi efetiva.

Abstract This article compares the findings of "Avaliação da Rede Cegonha" (ARC - Stork Network Assessment), an evaluative study on the Rede Cegonha (RC - Stork Network) program, with Nascer no Brasil (NB - Born in Brazil), a national survey on labor and birth, conducted in 2011-12, before the start implementation of RC. ARC was conducted in 2017, in 606 maternity hospitals involved in RC and NB included a sample with national representation of 266 hospitals. In the current analysis, we included the 136 SUS hospitals that participated in both studies, totaling 3,790 and 12,227 puerperal women. We perform comparisons of best practices and interventions in the management of labor and delivery using Pearson's chi-square test for independent samples. The prevalence of best practices was, on average, 150% higher in ARC than in NB, with a greater relative increase in less developed regions, for older, brown and black women and less educated. Regarding interventions, there was an average reduction of 30% between NB and ARC, with a greater relative reduction in less developed regions and less educated women. There was a significant improvement in the scenario of care for labor and childbirth, with a reduction in regional, educational and racial inequalities in access to appropriate technologies, suggesting that the RC intervention was effective.