Educational Inequalities in Adequate Antenatal Care Coverage in Niterói, Brazil (2014–2024)
1
Health Situation Room of Niterói/RJ/BR, Municipal Health Foundation of Niterói/RJ/BR, Niterói/RJ, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A2276
ABSTRACT
BACKGROUND:
Since 2016, the World Health Organization has recommended antenatal care models with a minimum of eight contacts as a strategy to reduce perinatal mortality and improve women’s experience of care. However, the implementation of this guideline remains uneven and strongly influenced by social determinants, such as maternal education. This study analyzes temporal trends in educational inequalities in the achievement of ≥8 antenatal visits in the city of Niterói/RJ between 2014 and 2024.
METHODS:
We conducted an ecological time-series study using data from the Brazilian Live Birth Information System (SINASC). Annual proportions of women achieving ≥ 8 antenatal visits were calculated by levels of maternal education (≤3; 4–7; 8–11; ≥12 years). Educational inequalities were assessed using simple (absolute difference and ratio) and complex (Slope Index of Inequality [SII] and Concentration Index [CIX]) measures.
RESULTS:
A persistent educational gradient was observed throughout the period, with higher coverage among women with ≥12 years of schooling (86.4%–92.0%) and lower coverage among those with ≤3 years (39.4%–75.0%). Across the historical series, coverage increased particularly among the least educated. Absolute inequalities declined substantially (difference from −52.6 to −11.4), as did relative inequalities (ratio from 0.43 to 0.87). Both complex measures remained positive, indicating that the adequate antenatal care was concentrated among women with higher education. However, a clear downward trend was observed, with the SII decreasing from 59.9 to 36.6 and the CIX from 11.4 to 6.4.
CONCLUSIONS:
The findings indicate progress in reducing inequalities in the access to adequate antenatal care coverage in Niterói over the last decade. These trends likely reflect improvements in primary health care and maternal health policies at the local level. However, the persistence of an educational gradient indicates the importance of assertive public health strategies to consolidate these improvements and ensure universal high-quality maternal care.
Since 2016, the World Health Organization has recommended antenatal care models with a minimum of eight contacts as a strategy to reduce perinatal mortality and improve women’s experience of care. However, the implementation of this guideline remains uneven and strongly influenced by social determinants, such as maternal education. This study analyzes temporal trends in educational inequalities in the achievement of ≥8 antenatal visits in the city of Niterói/RJ between 2014 and 2024.
METHODS:
We conducted an ecological time-series study using data from the Brazilian Live Birth Information System (SINASC). Annual proportions of women achieving ≥ 8 antenatal visits were calculated by levels of maternal education (≤3; 4–7; 8–11; ≥12 years). Educational inequalities were assessed using simple (absolute difference and ratio) and complex (Slope Index of Inequality [SII] and Concentration Index [CIX]) measures.
RESULTS:
A persistent educational gradient was observed throughout the period, with higher coverage among women with ≥12 years of schooling (86.4%–92.0%) and lower coverage among those with ≤3 years (39.4%–75.0%). Across the historical series, coverage increased particularly among the least educated. Absolute inequalities declined substantially (difference from −52.6 to −11.4), as did relative inequalities (ratio from 0.43 to 0.87). Both complex measures remained positive, indicating that the adequate antenatal care was concentrated among women with higher education. However, a clear downward trend was observed, with the SII decreasing from 59.9 to 36.6 and the CIX from 11.4 to 6.4.
CONCLUSIONS:
The findings indicate progress in reducing inequalities in the access to adequate antenatal care coverage in Niterói over the last decade. These trends likely reflect improvements in primary health care and maternal health policies at the local level. However, the persistence of an educational gradient indicates the importance of assertive public health strategies to consolidate these improvements and ensure universal high-quality maternal care.
| eISSN: | 2654-1459 |
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