Women living in the poorest areas in Brazil have limited access to proper healthcare services and adopt an unhealthy and risky lifestyle given their physical and social environment. This affects the health and well-being of the mother, increasing the risk of maternal mortality and complications during delivery, but also the life, the development and health of the unborn child.

Pregnant women in the favelas of Salvador do not know they are pregnant, that the pregnancy is unplanned and that do not have timely access to prenatal check-ups. It is doubtful whether educational and health campaigns run by local organizations targeting adolescents are effective. The rise of the Zika-virus has increased the importance of timely maternal health checks.

Local organizations in health promotion seem to fail to create awareness about family planning and maternal health risks, as women cope with unwanted pregnancy, experience access barriers to healthcare and do not get the maternal health check-ups in time.

To investigate the factors that affect the access to prenatal care for women in the favelas in Salvador de Bahía and subsequently facilitate the co-creation of a community-specific intervention to improve its access.

What kind of intervention can we co-create with the inhabitants of Salvador in Brazil to improve access to maternal health care?

What factors affect access to prenatal care?

How does the prenatal care system work?

What is, according to local stakeholders, the ideal situation with regards to access to prenatal care?

What solutions do local stakeholders see to improve access to prenatal care?

Interviews, Focus groups, Pubquiz

Maternal health, access

Prenatal care is not accessible due to the long waiting lines and the lack of spots to plan it.

According to the women from Baixa-Fria a significant barrier was getting up in the morning to go queue up at the health post to plan a consult for the following month. Yet, there’s only one day per month available to plan it. If there are no spots available, patients would have to come back next month or try another health post.

Furthermore, a card of the healthcare system – Sistema Único de Saúde (SUS) is needed to be able to plan a consult. To obtain this card some form of identification of residency is required. However, as the community is not recognized by the local government, a lot of people remain unregistered and therefore can’t enter the SUS and use basic healthcare services.

From interviews with healthcare workers at the health post, we can conclude that alternative ways to prove residency do exist. Nonetheless, for a lot of people living in communities it’s still a major impediment. Other issues reported by community members were e.g. on the way patients were treated by the health professionals, in particular at the maternity ward. Respondents claimed that if you didn’t make use of prenatal care prior to delivery, women were prejudiced as being lazy and irresponsible. It could even lead to disfavouring in being assisted. Even in the community, some women who were able to get prenatal care had this prejudice against those who didn’t get it.

1) increasing the chances for an individual to be able to get a prenatal consult planned and

2) to have access to the right information on the requirements and availability, so patients will be well prepared and do not have to queue up in vain.

We reported our results to the Brazilian Ministry of Health and officially formulated a complaint on the fact that at the local health post, for two months there were not admitted any new patients (pregnant women). The Ministry of Health now works together with our local researcher Susana in getting pregnant ladies documented and making sure they receive the right information.

During the Challenge the team also created an infographic which was handed out as a flyer to inhabitants of the community. Furthermore, the infographic was printed as a poster and distributed in different places in the community, such as the church. The flyer emphasized the importance of prenatal care and pointed out the various health posts’ availability and the required documents. The manager of the health post was invited to answer the questions of the community and to introduce him to the local leader. In this culture it is important to have a strong network and relationship- building is a step forward.

Through this first action, enabling local pregnant women in the Sanitary District of Pau da Lima to make use of prenatal care, local stakeholders can set up a strategy to open up access for future pregnant women as well. We will stay in contact in order to follow updates upon this process.