[Prenatal care in Latin America]. / La atención prenatal en América Latina.

ABSTRACT

PIP: This article describes the evolution of prenatal care in Latin America during the past 2 decades based on a literature review which utilized the Medline, Popline, and Lilacs (Pan American Health Organization) data bases. The results were compared to the findings of E. Royston and J. Ferguson from their article "The coverage of maternity care: a critical review of available information", published in the World Health Statistics Quarterly in 1985. Rates of antitetanus vaccination during pregnancy were included as an indicator of the content of prenatal care. A large quantity of data on prenatal care in Latin America was found, much of it from surveys with representative samples at the national level. Comparison of information was often difficult because not all countries nor all surveys used the same methodology. From 1985 on, only Bolivia had a coverage of prenatal care of less than 50%. In Chile, Cuba, the Dominican Republic, and Puerto Rico, over 90% of pregnant women had at least 1 prenatal consultation. Coverage in Cuba and Puerto Rico was higher than that in the US, but coverage in Bolivia was lower than in some African countries. Prenatal care increased during the 1970s and 80s in the Dominican Republic, Ecuador, Guatemala, Honduras, Mexico, and Peru, but declined in Bolivia and Colombia. 38.2% of deliveries in Guatemala, 21.3% in Honduras, and 12% in Mexico were attended by traditional midwives. In Honduras, 33.1% of deliveries were attended by midwives and public or private health institutions. Prenatal care was more common in urban than rural areas in all countries except Honduras. In Peru and Bolivia the coverage in rural areas was less than half that of urban areas. The educational differential in prenatal care was even more pronounced. The greatest difference was in Bolivia, where 85% of women with intermediate or higher educations had prenatal care, compared to only 13.9% of illiterates. Rates of tetanus immunization were always lower than for prenatal care except in Costa Rica. In Bolivia, Guatemala, and Peru, rates of tetanus immunization were less than half those of prenatal care. Rates of tetanus vaccination increased in almost all countries in recent years. Prenatal care is worthwhile only when it is effective, but numerous potential biases make effectiveness very difficult to evaluate. Even taking such biases into consideration, most studies have shown a positive effect of prenatal care. It is especially important to assess the effects and quality of prenatal care in countries like honduras and Guatemala that have relied on traditional midwives to increase their coverage. Improving the quality of prenatal care should be an objective complementary to increasing coverage.