Nearly all pregnant women in Brazil attend at least one prenatal appointment. However, one in five does not complete the minimum of seven visits recommended by the Ministry of Health since 2024 for adequate pregnancy monitoring.

The drop in coverage between the first and seventh prenatal visit, from 99.4% to 78.1%, disproportionately affects women with no formal education, Indigenous women, adolescents, and those living in Brazil’s North region.

The analysis was conducted by researchers from the International Center for Equity in Health at the Federal University of Pelotas (ICEH/UFPel), in partnership with Umane, an organization dedicated to strengthening public health in Brazil. Based on more than 2.5 million births recorded in Brazil’s Live Birth Information System (SINASC) in 2023, the findings are available through the Public Health Observatory and were also published in the International Journal for Equity in Health.

According to the researchers, Brazil’s health system has been successful in reaching nearly all pregnant women at the beginning of prenatal care, but still struggles to ensure continuity throughout pregnancy, particularly among the most vulnerable populations.

“Brazil has nearly universalized access to the beginning of prenatal care, but it still fails to ensure that this care continues until the end of pregnancy, leaving behind populations that are already vulnerable,” says Luiza Eunice Sá da Silva, researcher at ICEH/UFPel.

For Evelyn Santos, Social Investment and Impact Manager at Umane, the study helps qualify public debate on inequalities in prenatal care access. She highlights that identifying where continuity of care breaks down is essential to ensuring comprehensive maternal healthcare.

 

Education and race as key markers of inequality

Education is one of the strongest predictors of whether women complete the recommended seven prenatal visits. While 86.5% of women with 12 or more years of schooling reach this benchmark, the percentage drops to 44.2% among women with no formal education.

Racial inequalities are also significant. While 84.3% of White women complete seven visits, only 51.5% of Indigenous women do so. Rates are also lower among Black women (75.7%) and Brown/mixed-race women (75.3%).

One of the most concerning findings relates to continuity of care: coverage among Indigenous women drops by 46.2 percentage points between the first and seventh visit, a decline three times greater than that observed among White women.

When race and education intersect, inequalities become even more pronounced: only 19% of Indigenous women with no formal education complete seven visits, compared to 88.7% of White women with 12 or more years of schooling.

 

Regional and age-related disparities

Regional disparities are also evident. Brazil’s North region has the lowest coverage, with only 63.3% of pregnant women completing seven consultations. The highest coverage is found in the South (85%), followed by the Southeast (81.5%), Central-West (77%), and Northeast (76.1%).

Among adolescents under the age of 20, only 67.7% complete the full prenatal care cycle, compared to 82.6% of women over the age of 35.

Epidemiologist and study co-author Cesar Victora notes that the findings reinforce the “Inverse Equity Hypothesis,” which suggests that health advances tend to benefit more privileged groups first.

Because prenatal care is the main strategy for identifying and preventing complications during pregnancy, interruptions in follow-up may increase the risk of premature birth, low birth weight, and other adverse outcomes.

The researchers argue that equity must be at the center of public health policies, with targeted strategies to improve continuity of care among women with low levels of education, Indigenous populations, adolescents, and historically underserved regions.