ArticleInternational journal for equity in health2026
Exacerbation of antenatal care inequities as coverage recommendations rise in Brazil: evidence for the inverse equity hypothesis from national health information system data (SINASC) in 2023.
Article in International journal for equity in health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
Abstract
backgroundWithin-country inequalities in antenatal care (ANC) coverage are widely documented. With recent international guidelines recommending eight or more visits, we hypothesized that this increase could reveal wider inequalities in Brazil, consistent with the Inverse Equity Hypothesis, which postulates that new interventions initially widen socioeconomic gaps because privileged groups are the first to adopt them. We assess how the magnitude of inequality varies by increasing ANC visit thresholds.
methodsWe analyzed data from the Brazilian Live Births Information System (SINASC) for 2,537,511 live births in 2023, calculating national coverage 1 + to 8 + ANC visits. Estimates were stratified by maternal schooling, self-reported race/skin color, age at birth, and geographic region. Measures of inequality included the Slope Index of Inequality (SII) and the mean absolute difference to the overall mean (MADM).
resultsNational coverage for 1 + ANC visits was 99.4% and for 8 + visits, 67.4%. For maternal schooling, SII rose from 1.6% points (p.p.) for 1 + visit to 26.4 p.p. for 8 + visits. For 8 + visits, indigenous women showed the largest dropout rates and the lowest coverage (37.8%), whereas white women showed the opposite (74.7% coverage). The North region and adolescents also showed low coverage of 8 + ANC visits (50.8% and 55.4%, respectively).
conclusionsIncreasing the number of recommended ANC visits exacerbates socioeconomic, racial, and regional inequities in Brazil, consistent with the inverse equity hypothesis. Higher coverage thresholds disclose wider inequities, thus further exposing the vulnerability of indigenous, with no formal schooling, adolescent women and residents of the North. Improved detection of such inequities is essential to guide policies that ensure high-quality ANC reaches all women and children, thereby eliminating current inequalities in maternal and newborn health outcomes.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.