Saúde materna no Brasil: estudo ecológico de avaliação da implantação da rede cegonha

Abstract

Maternal health is an area of high interest for public health, the main indicator of which is the maternal mortality rate. High rates of this indicator are characteristic of underdeveloped countries such as Brazil, which can be avoided, most of the time, through actions such as quality prenatal care and adequate assistance in childbirth and postpartum. In this perspective, several policies were instituted to promote improvements in maternal health, among which the most current is the Stork Network, instituted in 2011. Thus, the general objective of this work is to assess maternal health before and after the implementation of the Stork Network in Brazil. To achieve this objective, it was proposed to conduct a quantitative study of the mixed ecological type, with an analytical character, on maternal health before and after the implementation of the Stork Network in Brazil, using the municipalities, intermediate regions of urban articulation as the unit of analysis, federation units and regions. In addition, the maternal mortality coefficient, adherence to the Stork Network, nine socioeconomic and demographic indicators, three indicators of maternal health quality and the coverage of primary care were considered as variables. All data that composed the variables were obtained from secondary sources of public access. For data treatment and analysis, Microsoft Office Excel, Statistical Package for the Social Science (SPSS) and Geoda software were used, in which graphs, tables, maps and statistical tests were made for analysis under the perspective of descriptive and inferential statistics, including spatial analysis. The results show that there was an increase in the average of the maternal mortality coefficient from 5.99 to 6.28 per 10,000 live births, from the period prior to the period after the implementation of the Stork Network, among which the highest coefficients were those in the Northern regions and Northeast, which also had the worst socioeconomic and demographic indicators. Among the municipalities in Brazil, 61.15% joined the Stork Network until the last year studied, with the highest percentages recorded in the North region. The correlation of maternal mortality with the Human Development Index variables, households with running water, life expectancy at birth, aging rate and schooling worsened from the first to the second period. The distribution of mean maternal mortality in relation to adherence to the Stork Network shows that in recent years the average of maternal mortality has been lower in the municipalities that adhered to the Stork Network than in those that did not adhere. The spatial correlation of adherence to the Stork Network with maternal mortality reveals significant high-high and low-high clusters located in the North, Northeast and Midwest regions, and low-low and highlow clusters located in the Southeast regions and South. Maternal health indicators reveal that after joining the Stork Network there was a constant increase in the breastfeeding coefficient, the number of prenatal consultations and the percentage of pregnant women who started prenatal care in the first trimester of pregnancy. The dispersion of the percentage of adhesion to the Stork Network with the percentage of coverage of primary care reveals that both increased concomitantly in the second period analyzed. It can be concluded that it is important to encourage the implementation of the Stork Network, which has been taking place gradually in the municipalities of Brazil from 2012 to 2017 (reaching 61% in the last year), aiming at uniformity in the processes of maternal and child health care. The increase in maternal mortality after the implementation of the Stork Network can be attributed to greater exposure to risk factors and changes in the lifestyle of women today, as well as to the improvement in the notification process of maternal deaths in recent years. In addition, in the long term there was a potential effect of lower maternal mortality in the municipalities that joined the Stork Network.