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Healthcare access and the patterns of maternal health care utilization among poor and non-poor women living in urban areas in Portugal

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DOI: 10.4236/health.2013.512265    3,637 Downloads   4,854 Views   Citations


Introduction: Studies on attitudes and practices are increasingly used but not specifically related to the motivations for the use of reproductive health care among women of fertile age, living in urban areas and in different social contexts. Objectives: The aim of this study was to estimate the associations between the variables of social status (degree of poverty in the studied groups) and the variables of fecundity (representations, tensions, practices and control of fertility) and, in addition, to compare access to health care in the different studied groups, assessing the association between use of maternal health care and poverty in urban areas. Design: A case-control study was conducted in the Municipality of Lisbon, Portugal, with a total sample of 1513 women of fertile age: 499 cases of women considered very poor were selected from the database of beneficiaries of RSI (Social Welfare Payment for Inclusion); 1014 controls (two controls for each selected case), divided as 507 poor women selected from the other beneficiaries of Santa Casa da Misericórdia in Lisbon and 507 non-poor women selected from four Health Centers from the Municipality of Lisbon, Portugal. A total of 1054 women answered the questionnaire: 304 cases (response rate of 61%) and 750 (response rate of 74%) controls. The statistical analysis involved descriptive analysis and multinomial logistic regression. Results: The analysis confirms the association between poverty and patterns and representations of fecun

dity regarding pregnancy planning. The results of this study thus show the existence of different distributions on several variables and the gradients of poverty. Regarding access to health care, the major impact of poverty on women is limiting access to pharmaceuticals. The incapacity to afford the cost of health care appears as a central aspect of access to health care. Conclusion: A number of factors seem to be associated with poverty in women, such as ethnicity, single motherhood, low household income, low household size, low educational level of women and marital status. The association of poverty with not planning the pregnancy of the last child on one hand and large household size on the other hand points to a vicious circle that sustains poverty and leads to extreme poverty. Limited financial access to health care seems to mediate the association between women’s poverty and low coverage with family planning as well as the lack of access to safe termination of pregnancy.

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Craveiro, I. , Ferrinho, P. , de Sousa, B. and Gonçalves, L. (2013) Healthcare access and the patterns of maternal health care utilization among poor and non-poor women living in urban areas in Portugal. Health, 5, 1954-1964. doi: 10.4236/health.2013.512265.


[1] Cockerham, W.C. (1988) Medical sociology. In: Smelser, N.J., Ed., Handbook of Sociology, Sage Publications, London, 575-599.
[2] Wilkinson, G.R. (1997) Socioeconomic determinants of health: Health inequalities: Relative or absolute material standards? BMJ, 314, 591-595.
[3] OECD (2003) Poverty and health. DAC Guidelines and Reference Documents.
[4] Phipps, S. (2003) The impact of poverty on health: A scan of research literature. Canadian Institute for Health Information Collected Papers, Otawa.
[5] Wagstaff, A. (2002) Poverty and health sector inequalities. Bulletin of World Health Organization, Theme Papers, 80, 97-105.
[6] Braveman, P. (2007) We also need bold experiments: A response to Starfield’s “Commentary: Pathways of influence on equity in health”. Social Science and Medicine, 64, 1363-1366.
[7] Whitehead, M. and Dahlgren, G. (2007) Concepts and principles for tackling social inequities in health: Leveling up part 1. Studies on social and economic determinants of population health, No 2. WHO Regional Office for Europe, Copenhagen.
[8] Bruto Da Costa, A. (1998) Exclusoes sociais. Coleccao Fundacao Mário Soares, Gradiva Editora, Lisboa.
[9] Bruto Da Costa, A. (1998) Depoimento. In: Pobreza, exclusao: Horizontes de intervencao. Debates Presidência da República, INCM.
[10] PORDATA (2013)
[11] Perista, H. (1991) A pobreza no feminino na cidade de lisboa. In: Colóquio Internacional, A Mulher em Debate. Centro de Estudos para a Intervencao Social, Lisboa.
[12] Santana, P. (2002) Poverty, social exclusion and health in Portugal. Social Science and Medicine, 55, 33-45.
[13] Neyer, G. (2003) Family policies and low fertility in Western Europe. Journal of Population and Social Security, 46-93.
[14] Cunha, V. (2004) A fecundidade das famílias Portuguesas. In: Wall, K., Ed., Famílias no Portugal Contemporaneo. Imprensa de Ciências Sociais/ICS, Lisboa.
[15] Eurostat (2001) European social statistics: Demography. European Communities, Luxembourg.
[16] INE (2001) Inquérito à Fecundidade e Família 1997. INE, Lisboa.
[17] Almeida, A.N. and André, I.M. (1995) Os padroes recentes da fecundidade em Portugal. Lisboa, CIDM.
[18] Almeida, A.N., André, I.M. and Lalanda, P. (2002) Novos padroes e outros cenários para a fecundidade em Portugal. Análise Social, No 163.
[19] Gwatkin, D. R., Bhuiya, A. and Victora, C.G. (2004) Making health systems more equitable. The Lancet, 364, 1272-1280.
[20] Hart, J.T. (1971) The inverse care law. The Lancet, 1, 405-412.
[21] Ziglio, E., Barbosa, R., Charpak, Y. and Turner, S. (2003) Health systems confront poverty. In Public Health Case Studies (no1). WHO Regional Office for Europe, Copenhagen.
[22] Sunil, T.S., Spears, D.W., Hook, L., Castillo, J. and Torres, C. (2008) Initiation of and barriers to prenatal care use among low-income women in San Antonio, Texas. Maternal and Child Health Journal, 14, 133-140.
[23] Delgado-Rodriguez, M., et al. (1997) Unplanned pregnancy as a major determinant in inadequate use of prenatal care. Preventive Medicine, 26, 834-838.
[24] Erbaydar, T. (2003) Utilization of prenatal care in poorer and wealthier urban neighborhoods in Turkey. European Journal of Public Health, 13, 320-326.
[25] Lyu, G.G. (1998) Birth outcomes and the effectiveness of prenatal care. Health Services Research, 32, 805-823.
[26] Delvaux, T., Buekens, P., Godin, I.E. and Boutsen, M. (2001) Barriers to prenatal care in Europe. American Journal of Preventive Medicine, 21, 52-59.
[27] Valente, P., Dias, C.M. and Garcia, A.C. (1999) Evolucao epidemiológica da mulher em Portugal. In Direccao Geral da Saúde, A Saúde da Mulher. Ministério da Saúde, Portugal.
[28] Mendonca, D. and Calado, B.P. (2002) Situacao da saúde reprodutiva em Portugal. In: Craveiro, I. and Ferrinho, P., Eds., Saúde reprodutiva no países e territórios de língua Portuguesa. Associacao para o Desenvolvimento e Cooperacao Garcia de Orta (AGO), Lisboa.
[29] Schlesselman, J.J. (1982) Case-control studies, design, conduct, analysis. Oxford University Press, New York.
[30] Daniel, W.W. (2005) Biostatistics: A foundation for analysis in the Health Sciences. 8th Edition, John Wiley & Sons Inc.
[31] Hosmer, D. and Lemeshow, S. (2000) Applied logistic regression. 2nd Edition, Wiley Series of Probability and Statistics, Wiley-Interscience Publication, New York.
[32] Craveiro, I. (2009) Mulheres em idade fértil e pobreza: Formas de acesso e padroes de utilizacao dos cuidados de saúde reprodutiva. PhD Thesis.
[33] Daly, M. (1992) Europe’s poor women? Gender in research on poverty. European Sociological Review, 8, 1-12.
[34] Ruspini, E. (2000) Women and poverty: A new research methodology. In: Gordon, D. and Townsend, P., Eds., Breadline Europe. The measurement of poverty (cap. VI). The Policy Press, Southampton.
[35] Comission of the European Communities (2008) Nondiscrimination and equal opportunities: A renewed commitment-COM 420, Commission staff working document Community, Instruments and Policies for Roma Inclusion, Brussels.
[36] Lerman, R.I. (1996) The impact of US family structure on child poverty and income inequality. Economica, 63, S119-S139.
[37] Lerman, R.I. (2002) Impacts of marital status and parental presence on the material hardship of families with children. Urban Institute and American University.
[38] Eggleston, E., et al. (2001) Unintended pregnancy and low birthweight in Ecuador. American Journal of Public Health, 91, 808-810.
[39] Wadsworth, M. and Butterworth, S. (2006) Early life. In: Marmot, T.M. and Wilkinson, R.G., Eds., Social Determinants of Health, 2nd Edition, University Press. Oxford.
[40] Whitehead, M., Dahlgren, G. and Evans, T. (2001) Equity and health sector reforms: Can low income countries escape the medical poverty trap? Lancet, 358, 833-836.
[41] Limwattananon, S., Tangcharoensathien, V. and Prakongsai, P. (2007) Catastrophic and poverty impacts of health payments: results from national household surveys in Thailand. Bulletin of the World Health Organization, 85, 600-606.
[42] Wagstaff, A. and Waters, H. (2005) How were the reaching the poor studies done? In: Gwatkin, D., Wagstaff, A. and Yazbeck, A., Eds., Reaching the poor—With health, nutrition and population services, what works, what doesn’t, and why. The World Bank, Washington DC.
[43] Gwatkin, D.R. (2003) How well do health programmes reach the poor. The Lancet, 361, 540-541.

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