Research carried out by the Oswaldo Cruz Foundation (Fiocruz) from November 2021 to August 2022 to assess the coverage and quality of Prenatal and Childbirth Care offered to indigenous women in Mato Grosso do Sul (MS) pointed out inequalities in access and adequate care for the needs of pregnant women in the state. The differences, according to the study, are due to the low percentage of prenatal care offered to these women in the state. According to Fiocruz, the researchers interviewed 469 indigenous women who received childbirth assistance in 10 municipalities in the state, considered a representative sample. In the city of Dourados, 121 indigenous people were interviewed, or 25.8% of the total. In Amambaí, 110 (23.5%); in Caarapó, 30 (6.4%); in Campo Grande, 48 (10.2%); in Aquidauana, 24 (5.1%); in Miranda, 63 (13.4%); in Iguatemi, 12 (2.6%); in Antônio João, 11 (2.3%) and, in Tacuru, 37 (7.9%). In addition to individual interviews, information from the pregnant woman’s booklet was analyzed. Most of the indigenous women heard were from the Guarani-Kaiowá (296/63.4%) and Terena (158, 33.8%) ethnic groups, lived in a village (404/86.1%) and had prenatal care in a basic health care unit. indigenous health (402, 85.7%). The study, approved in Public Policies, Models of Attention and Management of the Health System and Services (PMA) also showed that 51.5% of women had seven or more prenatal consultations (241); 37.2% (157) from 4 to 6 appointments; and 11.3% (53) had none or had had one to three appointments. “These percentages still reflect the low access to prenatal care, increasing complications for maternal and child health”, completed Fiocruz in a text about the research published on its website. Other information found in the study is that 66.3% of this population, or 311 women, started prenatal care in the first trimester and about 33.7%, or 158 in the second and third trimesters of pregnancy. For Fiocruz Mato Grosso do Sul researcher and study coordinator, Renata Picoli, the percentage of indigenous women starting prenatal care in the second and third trimesters of pregnancy is an indication of the difficulties in accessing prenatal care. Most 355 (75.7%) had a normal delivery, while the remaining 114 (24.3%) needed a cesarean section. According to Fiocruz, data from the Information System on Live Births (Sinasc) can be used for comparisons with the results of the study. According to Sinasc, the rate of cesarean births among non-indigenous women was 64.3% in 2020. Renata Picoli points out that there are several factors that can explain the low attendance. “Understanding the situations of social vulnerabilities experienced by the indigenous peoples of the state, characterized by territorial conflicts, health inequities, can help to understand the worst values of prenatal care”, she says in the text. Data from the Indigenous Missionary Council (Cimi) reveal that, from 2003 to 2019, 39% of the 1,367 murders of indigenous leaders in Brazil took place in Mato Grosso do Sul. Cesarean sections In the understanding of the international medical community, since 1985, the ideal rate of cesarean sections in deliveries would be 10% to 15%. Governments and health professionals have expressed concern about the increase in this procedure and its possible negative consequences on maternal and child health. According to researcher Renata Picoli, studies indicate that a cesarean section can entail immediate and long-term risks. “The risks may be greater for indigenous women who experience difficulties in geographic accessibility and who live on land located in municipalities with limited supply of obstetric care,” she said. Analysis Fiocruz informs that the results of the research will be able to subsidize the analysis of the situation of prenatal care and delivery of indigenous women. The intention is to discuss the data with indigenous communities and entities that provide health care for this population and propose a care strategy for indigenous pregnant and postpartum women. To increase the dissemination of the results, the research coordinator points out that the documentary Oguata das Pregnant Women and Indigenous Mothers of Mato Grosso do Sul, produced by the Associação de Jovens Indígenas and by Fiocruz Mato Grosso do Sul, will soon be released. “It will be a differentiator, as it brings indigenous perspectives and knowledge about the specificities of prenatal care, delivery and postpartum care for indigenous women”, emphasizes Renata. The work will continue with an assessment of the health and nutrition of women and children to accompany the indigenous women and their live births who participated in the prenatal and delivery survey. Field teams made up of researchers from Fiocruz Mato Grosso do Sul and people from the indigenous community will visit the women who were interviewed at the hospital the previous year. “11 villages will be visited in the state, with the perspective of assessing the health and nutrition of women and children up to 2 years of age, in addition to access to programs and services with repercussions on health”, informs Fiocruz. According to Fiocruz, home visits for the woman and child will be carried out in two stages, considering the child’s date of birth. The first, at 12 months, and the other, at 24 months of age. “Through interviews, there will be an assessment of attendance and access to civil registration, income transfer and food and health security programs; survey of records on the child’s booklet, anthropometry (verification of weight and height of mother and child) and blood hemoglobin measurement of mother and child (anemia); measurement of blood pressure and glucose dosage (serology for covid-19, arterial hypertension and diabetes in women).” Renata Picoli points out that the follow-up study is unprecedented and can provide results on the health conditions of indigenous women and children, by subsidizing appropriate public policies with an emphasis on the specificities of the indigenous population. The report by Agência Brasil asked for an evaluation by the Ministry of Health on the result of the research, but had not received a response until the publication of this text.
Agência Brasil
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