The impact of social determinants of health on prenatal care among pregnant women attending a Basic Healthcare Unit in Porto Alegre, Rio Grande do Sul

Abstract

Introduction: Social Determinants of Health, such as income, education, and living conditions, directly influence the quality of prenatal care, which may contribute to inequalities in access and outcomes of care for pregnant women. Primary Health Care, through Basic Health Units (UBS; Unidade Básica de Saúde), plays a central role in the early identification of vulnerabilities and in the provision of comprehensive, continuous, and culturally sensitive care. Objective: To evaluate whether there is a relationship between the Social Determinants of Health and the follow-up of pregnant women who received prenatal care at UBS Santa Cecília, city of Porto Alegre, in Rio Grande do Sul state. Methods: This is an observational, cross-sectional study involving 103 pregnant women at UBS Santa Cecília who received prenatal care from January to December 2023. Clinical and obstetric data collected from electronic medical records were evaluated, including the number of prenatal visits, gestational age at the first visit, and laboratory screening tests for sexually transmitted infections during pregnancy. Results: The results showed a statistically significant difference in gestational age at the start of prenatal care between beneficiaries of the Bolsa Família Program and non-beneficiaries, with a mean of 6.68 weeks and 12.07 weeks, respectively (p=0.036 by the Mann-Whitney U test for independent samples). All pregnant women evaluated underwent laboratory tests to screen for sexually transmitted infections, and there was no statistically significant difference between the groups by race/color, age, and educational level regarding the total number of consultations and gestational age at the first consultation. Conclusions: The results indicate that Social Determinants of Health influence prenatal care follow-up, particularly regarding the earlier initiation of care among pregnant women who are beneficiaries of the Bolsa Família Program. Although no significant differences were observed in the total number of prenatal visits and in the performance of laboratory screening tests across different sociodemographic groups, the findings reinforce the role of Primary Health Care in promoting equity and reducing inequalities in access to prenatal care. The importance of early identification of social vulnerabilities by health care teams is highlighted as a strategy to improve the quality of care and ensure comprehensive support for pregnant women.