Inequalities in the geographic access to delivery services in Brazil

BACKGROUND: Despite Brazil's recent social progress, access to health services is still unequal. This article analyzes the inter-municipal distances traveled by pregnant women to access delivery services, documenting their magnitude and relationship to socioeconomic and risk factors for over a decade in Brazil. METHODS: Using data between 2007 and 2017 from the Brazilian Information System of Live Births and a matrix of inter-municipal distances, we describe the evolution of (i) the share of pregnant women that traveled across municipalities and (ii) the average distance they traveled. Next, we assess which of the previous variables explains the changes in travel distance over time. Finally, we estimate the difference in the average travel distance by individual risk factors and use regression analysis to measure the association between this distance and municipal socioeconomic determinants from the Brazilian census. RESULTS: We observe that, on average, (i) the share of women traveling for childbirth increased, reaching 31% in 2017, and (ii) distances got longer, approaching the 60-kilometer mark by 2017. The increase in distance is mainly due to more women traveling. Nevertheless, regional disparities persist, especially between the north/inland and coastal regions. Women with high-risk pregnancies or newborns with risks such as low birth weight tend to travel longer distances. However, those residing in higher-development municipalities tend to travel shorter distances. CONCLUSION: Long distances remain an obstacle to accessing delivery facilities. This matter affects the most vulnerable disproportionately. Policymakers must consider the geographic accessibility of mothers when expanding birth-related services. Additionally, more research is required to understand the decision to travel and the distance effectively traveled as different accessibility facets.