Is parenthood associated with self-rated health among women in Brazil?

BACKGROUND: Previous studies conducted in Europe and North America addressing the relationship between self-rated health and parenthood offer inconsistent results, with effects ranging from nonsignificant to significant and in opposite directions. The aim of the present study was to explore the relationship between parenthood and self-rated health (SRH) among women in Brazil (a country with strong inequalities) considering the time interval from the last delivery in the analyses, as proposed in previous studies set in Sweden. METHODS: The study used data from cross-sectional National Health Surveys in Brazil conducted from 2013 to 2014 and 2019 to 2020 with selected groups of 20,046 and 25,100 women for whom complete data were available on the variables of interest. The primary outcome was self-rated health measured on a five-point scale. Partial proportional odds models were employed. RESULTS: Compared to women that were not a parent, primiparous women whose delivery was within less than one year had a lower likelihood of worse SRH (OR (95% CI): 0.58-0.84 in 2013, and 0.64-0.94 in 2019), whereas multiparous women whose last delivery was more than one year earlier had greater likelihood of worse SRH (OR (95% CI): 1.08-1.27 in 2013, and 1.21-1.39 in 2019). CONCLUSIONS: An association was found between parenthood and SRH among Brazilian women. Considering the epidemiological relevance of SRH, different aspects of parenthood concerning parity and time since the last delivery should be considered in further analyses.

Live births of immigrant mothers in Brazil: A population-based study.

Introduction: Migration has become a major challenge for many countries, and women constitute half of the migrants in the world. Few studies have been conducted on migrant mothers in Brazil. We aim to identify differences in the pregnancies, childbirths, and live birth (LB) indicators of immigrant women, compared with those of Brazilian women living in the municipality of São Paulo (MSP), Brazil. Methods: The LB characteristics of immigrant mothers from Bolivia (15,886), China (3861), Paraguay (1370), and Peru (1039) were compared with those of Brazilian mothers (967,921) living in the MSP between 2012 and 2017. Pearson's chi-square test was used to compare proportions with a significance level of 5%. Results: Teenage pregnancy and low education were more frequent among Bolivian (13.1 and 31.7%, respectively) and Paraguayan mothers (13.1 and 36.2%). Bolivian women exhibited a high percentage of late-onset prenatal care (8.7%), few prenatal visits (14.3%), vaginal birth (77.0%), home delivery (1.6%), and postterm (3.6%). Bolivian (13.6%), Peruvian (10.6%), and Paraguayan (7.9%) women exhibited a higher prevalence of macrosomia than Chinese (4.3%) and Brazilian (4.0%) women. There was a high prevalence of preterm and low birth weights among Paraguayan (12.5 and 7.7%, respectively) and Brazilian mothers (11.0 and 9.7%) and a high rate of cesarean sections among Chinese (42.1%) and Brazilian (53.5%). Conclusion: Differences were observed in the sociodemographic profiles for the pregnancies, childbirths, and LBs of immigrant mothers, in view of their increase and diversity in the MSP. There was greater vulnerability among immigrant mothers, compared with Brazilian mothers, particularly regarding access to prenatal care.

Spatiotemporal dynamics of syphilis in pregnant women and congenital syphilis in the state of São Paulo, Brazil.

We aimed to estimate the occurrence of syphilis in pregnant women (SPW) and congenital syphilis (CS) in the municipalities of the state of São Paulo (SP) and evaluate their relationship with socioeconomic, demographic, and health care variables. We developed an ecological study based on secondary data of SPW and CS with spatiotemporal components from 645 municipalities in SP including data from 2007 to 2018. We modeled the data in a Bayesian context, considered spatial and temporal random effects, and used binomial negative probability distributions. We found a continuous increase in the relative temporal risk of SPW, from 2007 to 2018, and CS, from 2007 to 2017, when their incidences increased by 8.6 and 6.6 times, respectively. This increase occurred en bloc in practically all municipalities of SP. The increase in SPW was associated with teenage pregnancy, municipalities with a large number of inhabitants, and acquired immunodeficiency syndrome (AIDS) incidence. The increase in CS was associated with municipalities with a large number of inhabitants, incomplete antenatal care, and AIDS incidence. Although actions to control these diseases are required in all municipalities of SP, the identification of high-risk areas points to priority regions for development.

Intra-urban differentials of fetal mortality in clusters of social vulnerability in São Paulo Municipality, Brazil.

This study aimed to analyze the distribution of stillbirths by birth weight, type of death, the trend of Stillbirth Rate (SBR), and avoidable causes of death, according to social vulnerability clusters in São Paulo Municipality, 2007-2017. Social vulnerability clusters were created with the k-means method. The Prais-Winsten generalized linear regression was used in the trend of SBR by < 2500 g, ≥ 2500 g, and total deaths analysis. The Brazilian list of avoidable causes of death was adapted for stillbirths. There was a predominance of antepartum stillbirths (70%). There was an increase in SBR with the growth of social vulnerability from the center to the outskirts of the city. The cluster with the highest vulnerability presented SBR 69% higher than the cluster with the lowest vulnerability. SBR ≥ 2500 g was decreasing in the clusters with the high vulnerability. There was an increase in SBR of avoidable causes of death of the cluster from the lowest to the highest vulnerability. Ill-defined causes of death accounted for 75% of deaths in the highest vulnerability area. Rates of fetal mortality and avoidable causes of death increased with social vulnerability. The trend of reduction of SBR ≥ 2500 g may suggest improvement in prenatal care in areas of higher vulnerability.

What is the impact of interventions that prevent fetal mortality on the increase of preterm live births in the State of Sao Paulo, Brazil?

BACKGROUND: There is a global growing trend of preterm births and a decline trend of fetal deaths. Is there an impact of the decline of fetal mortality on the increase of preterm live births in State of Sao Paulo, Brazil? METHODS: The time trends were evaluated by gestational age through exponential regression analysis. Data analyzed included the fetal mortality ratio, proportion of preterm live births, fertility rate of women 35 years and over, prenatal care, mother's education, multiple births and cesarean section deliveries. A survival analysis was carried out for 2000 and 2010. RESULTS: Preterm births showed the highest annual increase (3.2%) in the less than 28 weeks of gestation group and fetal mortality ratio decreased (7.4%) in the same gestational age group. There was an increase of cesarean section births and it was higher in the < 28 weeks group (6.1%). There was a decreased annual trend of mothers with inadequate prenatal care (6.1%) and low education (8.8%) and an increased trend in multiple births and fertility rates of women of 35 years and over. The variables were highly correlated to which other over time. In 2000, 8.2% of all pregnancies resulted in preterm births (0.9% in fetal deaths and 7.3% in live births). In 2010, the preterm birth increased to 9.4% (0.8% were preterm fetal deaths and 8.6% preterm live births). CONCLUSIONS: The results suggest that 45.2% could be the maximum contribution of successful interventions to prevent a fetal death on the increase in preterm live births. This increasing trend is also related to changes of the women reproductive profile with the change of the women reproductive profile and access to prenatal care.

[Spatial analysis of live birth clusters in Unified Health System (SUS) and private hospitals in the municipality of São Paulo, Brazil]. / Análise espacial dos aglomerados de nascimentos ocorridos em hospitais SUS e não SUS do município de São Paulo, Brasil.

The scope of this study is to evaluate the spatial distribution of live births (LB) in the Municipality of São Paulo (MSP), verify if there is spatial dependence, identify possible differences in birth profiles and evaluate the distances between homes and delivery hospitals. LB occurring in high complexity hospitals were studied, namely 4 from the Unified Health System (SUS) and 4 from the private network in MSP in 2008. 46,190 LB were geocoded: 48.8% from SUS hospitals and 51.2% from private hospitals, accounting for 27.9% of total live births in MSP. LB in SUS hospitals formed two clusters, with a high proportion of households with incomes of 1/2 to 2MW and a marked number of shantytowns and high birth rates. LB in private hospitals formed a cluster in the central region of MSP, where there is a high proportion of households with > 10 MW income and a low birth rate. Differences in maternal, pregnancy and childbirth characteristics were statistically significant in SUS and non-SUS hospitals, as well as the frequency of multiple births. There was no difference in the prevalence of low birth weight and pre-term births. The results showed differences in the LB cluster profile reflecting the current inequalities in living conditions.

[Socio-demographic profile and utilization patterns of the public healthcare system (SUS), 2003-2008]. / Perfil sociodemográfico e padrão de utilização dos serviços de saúde do Sistema Único de Saúde (SUS), 2003-2008.

PNAD data was employed to analyze the utilization profile of health services, and this was measured by the proportion of individuals seeking and reporting use of health services in the prior two weeks and those who reported hospitalization in the preceding 12 months. Private health plans covered 25.9% of the Brazilian population. Comparing data from 2003 and 2008 surveys, there was no change in the proportion of individuals seeking health services, as well as the proportion of those attended by these services (96%). The Unified Health System (SUS) was responsible for 56,7% of all healthcare, providing the bulk of medical visits, vaccine activities and hospital admissions, but accounted for only 1/3 of dental care. There was a reduction in SUS health services utilization with the increase of education and income level, in the two surveys. There was also a decrease in utilization of services due to prevention and an increase in dental problems, accidents, injuries and rehabilitation. The pattern of SUS services utilization per region was inversely related to the proportion of individuals with private health insurance coverage.

Gender and health inequalities among adolescents and adults in Brazil, 1998.

OBJECTIVES: To assess the extent of gender inequalities in health status and health services utilization among adolescents and adults in Brazil. METHODS: A representative sample of 217,248 individuals from 15 to 64 years of age was obtained from the National Household Sample Survey (Pesquisa Nacional de Amostras por Domicílios, PNAD) conducted in 1998 by the Brazilian Institute of Geography and Statistics and funded by the Ministry of Health. The study focused on three outcome variables (self-assessed health status, medical visits, and hospitalizations (except childbirth)) and five exposure variables (age, gender, ethnicity, income, and education). Unconditional logistic regression and Mantel-Haenszel stratified analysis was employed. Prevalence rate ratios were calculated for each stratum. Confidence intervals were calculated using the Taylor series, with a 95% confidence interval (95% CI). RESULTS: Women were more likely to report fair or poor health than men (odds ratio (OR) = 1.33; 95% CI: 1.31-1.35). Gender disparities were significant for all ages, household income brackets, and education levels, and were always unfavorable to women (1.17 < or = OR < or = 1.44). Gender disparities for medical visits were higher for those in good health; tended to fall as age, income, and education increased; and were always favorable for women (1.12 < or = OR < or = 2.06). Gender disparities in hospitalization rates decreased with age, varied according to income and education level in each age group, and were always favorable for women (1.16 < or = OR < or = 1.66). CONCLUSIONS: The difference in self-reported health status for men and women became even greater after adjusting for socioeconomic variables, suggesting that poorer women have more pronounced, relative differences than men do. The impact of structural determinants, such as education and income, is considerably smaller than the social construct of gender, although the former are more important predictors. Women use health services more often than men do, which is consistent with their health needs. However, medical visit rates show an inverse relationship to health care needs, suggesting an inequitable access to outpatient care, mainly preventive care.

Health inequalities based on ethnicity in individuals aged 15 to 64, Brazil, 1998.

This study aimed to analyze inequalities in health status and utilization of medical consultations and hospital services by Brazilian young and adult populations according to ethnicity. The survey analyzes a representative sample of the Brazilian population aged 15 to 64 years, except those living in the rural area of the Amazon. The prevalence of fair or poor health status was substantially higher among black men, white women, and black women. The influence of gender and ethnicity remains significant after adjusting for age and socioeconomic conditions (OR = 1.11; 1.49 and 1.86 respectively). Differences between blacks and whites decrease with age, but increase with socioeconomic status. There were 10% more medical consultations among white individuals. The differences were more striking among young people who reported good health status. For individuals with fair or poor health, no differences were observed in frequency of medical consultations between blacks and whites. There were no significant differences in hospitalization rates. With regard to health status, differences between blacks and whites were striking. However, the same was not true for utilization of health services.