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BMC Health Serv Res. 2019 Nov 20;19(1):851. doi: 10.1186/s12913-019-4566-3.

Access to public health services and integral care for women during the puerperal gravid period period in Ceará, Brazil.

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Master in Nursing, Regional University of Cariri, Rua Coronel Antônio Luiz, 1161 - Pimenta, Crato, CE, 63105-010, Brazil.
Faculty of Medicine of ABC, Santo André, São Paulo, Brazil.
Master in Nursing, Regional University of Cariri, Rua Coronel Antônio Luiz, 1161 - Pimenta, Crato, CE, 63105-010, Brazil.



Over time, the Brazilian health system, a growing country, has been developing to ensure good accessibility to health goods and services. This development is focusing on the principle of universality of access and completeness of health care. In this context, we aimed to evaluate the completeness of care and universality of access for women in their pregnancy and puerperal period in Ceará, Brazil.


A descriptive, cross-sectional study based on a quantitative approach, using information collected from the database of the regulation system of the state of Ceará and data from the Prenatal Monitoring System. The research population comprised of 1701 women who delivered a baby in an obstetric reference unit in the Health Macro-Region of Cariri, Ceará, Brazil from January to December 2015.


There was a high rate of cesarean delivery (49.7%) and a high waiting time for access to high-risk delivery (32.6%) and neonatal intensive care unit (72.9%). There was also a low percentage (41.1%) of pregnant women undergoing an adequate number of prenatal consultations, dental care (20%), educational activities (15%), visits to the maternity ward (0.1%), laboratory tests of the third trimester (29.2%) and puerperal consultation (37.9%).


It was concluded that the Maternal and Child Health Policy, especially the Rede Cegonha, which is still under development, does not ensure access and completeness of care for women during the prenatal, delivery, and puerperal periods, thus violating their reproductive rights. The results of this study allow a critical analysis by the academia and health managers in search of strategies to improve the services of Rede Cegonha in Brazil.


Access to health services; Child health; Health completeness; Health regulation and surveillance; Right to health; Women’s health

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