Who are the women having non-institutional deliveries in Brazil and who attends them? An analysis of 13.7 million births (2018-2022)

Resumen

Objective: Over 13 million pregnancies in Brazil were analyzed to identify groups of women more likely to have deliveries outside health facilities, applying an equity approach to assess social determinants. Additionally, the types of professionals attending these deliveries were examined. Methods: Data from the Live Birth Information System (SINASC) from 2018 to 2022, were used to investigate non-institutional deliveries according to the region of residence, ethnicity/skin color, schooling, and age, as well as the intersections of these factors. The proportion of births attended by doctors, nurses/midwives, traditional birth attendants, and others was also analyzed, comparing institutional and non-institutional deliveries. Results: The overall prevalence of non-institutional deliveries was 1.0%. Higher proportions were observed in the North region (4.0%), among Indigenous women (26.3%), adolescent mothers (1.4%), and those with less than four years of schooling (8.3%). The proportion of non-institutional delivery rose to 67.6% among low-educated, Indigenous women from the North region. Indigenous women with less than 4 years of schooling and having a non-institutional delivery presented the highest proportion of delivery without a qualified professional (95.2%). Conclusions: Cultural norms and barriers to accessing maternity services, combined with broader social inequalities and organizational challenges faced by Indigenous populations, may contribute to the high proportion of these deliveries observed among these women. Culturally sensitive strategies to expand access and empower Indigenous women are crucial to ensuring their survival as well as their children’s.