RACIAL INIQUITY IN PRENATAL ACCESS IN THE FIRST QUARTER OF PREGNANCY: A SYSTEMATIC REVIEW AND METANALYSIS
Prenatal Care. Access to Health Services. Racial Factors
Access to prenatal care is the main promoter of healthy birth and the main preventive measure of maternal mortality from preventable causes in primary care. Early entry to this service makes it possible to reach the appropriate number of consultations, as well as the performance of the recommended procedures and suitability definers. Race / skin color is an important predictor of the population's health status, as well as a marker of social inequalities. The objective was, then, to carry out a systematic review of the literature and meta-analysis of cross-sectional studies, to identify the prevalence of access to prenatal care in the first trimester of pregnancy according to race or ethnicity and its magnitude of association. The protocol for this review is registered on the PROSPERO platform under number CRD42020159968. Searches were conducted at PUBMED, LILACS, Web of Science, Scopus, CINAHL and in the gray literature (Google Scholar and Opengray), using the descriptors "pregnancy", "prenatal" and "Accessibility to health services". The quality of studies and the risk of bias were analyzed using the Joanna Briggs Critical Assessment Checklist for Cross-Sectional Analytical Studies. After the analysis steps, 17 studies were included in this review. The extracted data were tabulated and distributed qualitatively and quantitatively through meta-analysis. It was observed that, in most of the included studies, black women were those who had less access to prenatal services in the first trimester, with a prevalence of access ranging from 53% to 56.4%; white women between 74% and 76.5%; and those of other ethnicities from 64.2% to 68.8%. In the quantitative analysis of the data, it was found that black women, when compared to white women, had a 43% less chance (OR = 0.57 95% CI 0.51-0.64) of obtaining obstetric care in the first trimester, and of 22% less chances when compared with women of other ethnicities (OR = 0.78 CI 95% 0.65-0.95). Thus, it is concluded that black women, even when contrasted with white and other minorities of similar sociodemographic characteristics, still received a difficulty in accessing maternal health services, and it can be inferred that the issue of race / skin color is itself an important determinant in obtaining obstetric care, requiring the development of public policies aimed at this population and expanding their access to health services.