Geographic accessibility to hospital childbirths in Brazil (2010-2011 and 2018-2019): a cross-sectional study

Priscila Costa Albuquerque; Lucas Lopes Felipe; Juliana Freitas Lopes; Wagner de Souza Tassinari; Fabio Zicker; Bruna de Paula Fonseca

doi:10.1016/j.lana.2024.100976

Geographic accessibility to hospital childbirths in Brazil (2010-2011 and 2018-2019): a cross-sectional study

Lancet Reg Health Am. 2024 Dec 27:42:100976. doi: 10.1016/j.lana.2024.100976. eCollection 2025 Feb.

Authors

Priscila Costa Albuquerque¹, Lucas Lopes Felipe², Juliana Freitas Lopes¹, Wagner de Souza Tassinari³, Fabio Zicker¹, Bruna de Paula Fonseca¹

Affiliations

¹ Center for Technological Development in Health (CDTS), Oswaldo Cruz Foundation (Fiocruz), Av. Brasil 4036, Rio de Janeiro, 21040-361, RJ, Brazil.
² Post Graduation Program in Informatics (PPGI), Department of Computer Science, Federal University of Rio de Janeiro (UFRJ), Av. Athos da Silveira Ramos 274, Cidade Universitária, Rio de Janeiro, 21941-916, RJ, Brazil.
³ Mathematics Department, Federal Rural University of Rio de Janeiro, BR-465, Km 7 Seropédica, Rio de Janeiro, 23897-000, RJ, Brazil.

Abstract

Background: Delays in obstetric care are associated with adverse maternal outcomes, while long-distance travel for delivery is associated with high neonatal mortality and increased maternal morbidity. Distance and travel time are key components of geographic accessibility to health services and important risk indicators for maternal and neonatal care. This study evaluated whether the Brazilian Unified Health System (SUS) has been geographically accessible in providing hospital childbirth services, over time.

Methods: Geographic accessibility to hospital deliveries in Brazil was mapped over two biennia (2010-2011 and 2018-2019), spanning a 10-year period, using national aggregated data from SUS Hospital Admissions Authorizations. Travel flows, distances, and times between women's municipalities of residence and hospitals were estimated.

Findings: A total of 6,930,944 hospital deliveries were analyzed. Overall, 25.4% (n = 1,759,306) of pregnant women traveled outside their municipalities to give birth in SUS hospitals, increasing from 23.6% (n = 843,501) in 2010-2011 to 27.3% (n = 915,805) in 2018-2019. Distance and travel time rose by 31.1% (54.0 km-70.8 km) and 33.6% (63.1-84.3 min), respectively. Women experiencing maternal and/or neonatal death traveled longer distances and times. Regional disparities were evident: the Northeast had the highest proportion of women traveling (35.6%; n = 817,499), and the North had the lowest (16.0%; n = 138,295). Women in the North faced the longest travel distances (97.5-133.4 km) and times (1,012-1,850 min), while those in the Southeast and South experienced the shortest distances (37.2-55.9 km and 41.2-54.8 km, respectively) and times (38-52 min and 41-52 min).

Interpretation: The results highlight regional disparities in maternal health service access within the SUS, which may affect maternal and neonatal outcomes. Targeted public health measures are needed to improve the availability of service, particularly in the North and Northeast regions, where access issues are most severe.

Funding: Fundação Oswaldo Cruz; CNPq; FAPERJ.

Keywords: Brazil; Geographic accessibility; Health equity; Health services accessibility; Hospital deliveries; Maternal health services; Travel distance.