Rev Cuid. 2025; 16(2): 4406

https://doi.org/10.15649/cuidarte.4406

RESEARCH ARTICLE

Factors associated with low adherence to postpartum consultation: a cross-sectional study

Factores asociados a baja adherencia a la consulta postparto: un estudio transversal

Fatores associados à baixa adesão da consulta puerperal: um estudo transversal

Universidade do Estado da Bahia, Senhor do Bonfim, Brasil. E-mail: a.luisa.amorim8@gmail.com Ana Luísa Macedo de Amorim
Universidade do Estado da Bahia, Senhor do Bonfim, Brasil. E-mail: cdsena@uneb.br Chalana Duarte de Sena Fraga
Universidade do Estado da Bahia, Salvador, Brasil. E-mail: tacilanogueira@yahoo.com.br Tacila Nogueira Azevedo Rocha
Universidade do Estado da Bahia, Senhor do Bonfim, Brasil. E-mail: kellenkaroline2011@hotmail.com Correspondence Author Kellen Karoline Almeida dos Santos Lira
Universidade do Estado da Bahia, Senhor do Bonfim, Brasil. E-mail: msandrade@uneb.br Magna Santos Andrade

Highlights

 

How to cite this article: De Amorim, Ana Luísa Macedo; Fraga, Chalana Duarte de Sena; Rocha, Tacila Nogueira Azevedo; Lira, Kellen Karoline Almeida dos Santos; Andrade, Magna Santo. Factors associated with low adherence to postpartum consultation: a cross-sectional study. Revista Cuidarte. 2025;16(2): e4406. https://doi.org/10.15649/cuidarte.4406

Received: September 2nd 2024
Accepted: February 12th 2025
Published: May 1st 2025

CreativeCommons 

E-ISSN: 2346-3414

Abstract

Introduction: One of the attributes that attest to the effectiveness of postpartum care is the longitudinality of health care, which must be offered by Primary Health Care, an entity responsible for offering support and attention to maternal demands or women's health conditions. Objective: To investigate the frequency of postpartum consultations and the factors associated with low adherence to follow-up among postpartum women living in a municipality in the interior of the Northeast. Materials and Methods: Cross-sectional study, developed in the urban area of the municipality of Senhor do Bonfim, Bahia, Brazil, between June 2019 and January 2020. 97 women were surveyed, based on semi-structured interviews. The Chi-square/Fisher's Exact and Multiple Logistic Regression tests were used to perform data analysis. Results: There was 67% attendance at the postpartum consultation. Furthermore, an association was found between not having attended a postpartum consultation and the following variables: having attended prenatal care at the Basic Health Unit (OR: 0.08; p=0.002) and not having received guidance during prenatal care about the importance of returning for postpartum follow-up (OR: 0.22; p=0.004). Discussion: It is important to highlight that even with the existence of national protocols, states and municipalities can implement measures to improve postpartum care based on their respective realities. Conclusions: A low frequency of postpartum consultations was observed among the women surveyed, and the main reason for non-attendance was the difficulty in going to the consultation due to lack of time. In addition, the lack of continuity of care after childbirth among women who attended prenatal care at the SUS stands out.

Keywords: Comprehensive Health Care; Primary Health Care; Postpartum Period; Women's Health.

Resumen

Introducción: Uno de los atributos que dan fe de la efectividad de la atención puerperal es la longitudinalidad de la atención en salud, la cual debe ser ofrecida por la Atención Primaria de Salud, entidad encargada de ofrecer apoyo y atención a las demandas maternas o condiciones de salud de la mujer. Objetivo: Investigar la frecuencia de consultas posparto y los factores asociados a la baja adherencia al seguimiento entre puérperas residentes en una ciudad del interior del Nordeste. Materiales y Métodos: Estudio transversal, desarrollado en el área urbana del municipio de Senhor do Bonfim, Bahía, Brasil, entre junio de 2019 y enero de 2020. Se encuestaron 97 mujeres, mediante entrevistas semiestructuradas. Para realizar el análisis de datos se utilizaron pruebas de Chi-cuadrado/regresión exacta de Fisher y regresión logística múltiple. Resultados: Hubo 67% de asistencia a la consulta postparto. Además, se encontró asociación entre no haber asistido a consulta de posparto y las siguientes variables: haber asistido a control prenatal en la Unidad Básica de Salud (OR: 0,08; p=0,002) y no haber recibido orientación en el control prenatal sobre la importancia de regresar. para el seguimiento posparto (OR: 0,22; p=0,004). Discusión: Es importante resaltar que si bien existen protocolos nacionales, los estados y municipios pueden implementar medidas que mejoren la atención posparto en función de sus respectivas realidades. Conclusiones: Se observó una baja frecuencia de consultas postparto entre las mujeres encuestadas, siendo el principal motivo de inasistencia la dificultad para acudir a la consulta por falta de tiempo. Además, se destaca la falta de continuidad de la atención después del parto entre las mujeres que recibieron atención prenatal a través del SUS.

Palabras Clave: Atención Integral de Salud; Atención Primaria de Salud; Periodo Posparto; Salud de la Mujer.

Resumo

Introdução: Um dos atributos que atestam a eficácia da assistência puerperal é a longitudinalidade do cuidado em saúde, que deve ser ofertada pela Atenção Primária a Saúde, entidade responsável por ofertar acolhimento e atenção às demandas maternas ou condições de saúde da mulher. Objetivo: Investigar a frequência da consulta de pós-parto e os fatores associados à baixa adesão do acompanhamento entre puérperas residentes de um município do interior do Nordeste. Materiais e Métodos: Estudo transversal, desenvolvido na zona urbana do município de Senhor do Bonfim, Bahia, Brasil, entre junho de 2019 a janeiro de 2020. Foram pesquisadas 97 mulheres, a partir da entrevista semiestruturada. Os testes Qui-quadrado/Exato de Fisher e Regressão Logística Múltipla foram utilizados para realizar a análise de dados. Resultados: Houve 67% de comparecimento à consulta puerperal. Além disso, constatou-se associação entre não ter realizado consulta de pós-parto e as seguintes variáveis: ter realizado o acompanhamento pré-natal na Unidade Básica de Saúde (OR: 0,08; p=0,002) e não ter recebido orientação no pré-natal sobre a importância do retorno para o acompanhamento no pós-parto (OR: 0,22; p=0,004). Discussão: É importante destacar que mesmo existindo protocolos nacionais, os estados e municípios podem implementar medidas que melhorem a atenção no pós-parto a partir das respectivas realidades. Conclusões: Observou-se uma baixa frequência de consultas puerperais entre as mulheres pesquisadas, sendo que o principal motivo do não comparecimento foi a dificuldade de ir à consulta em virtude da falta de tempo. Além disso, destaca-se a falta da continuidade da assistência após o parto entre as mulheres que realizaram o pré-natal no SUS.

Palavras-Chave: Assistência Integral à Saúde; Atenção Primária à Saúde; Período Pós-Parto; Saúde da Mulher.

 

Introduction

The puerperium, period experienced for the woman since the expulsion from the placenta up to an average of six weeks after giving birth, this is a delicate moment in a woman's life due to the physical, psychological and social changes experienced. In this scenario, the injuries, pain and trauma resulting from childbirth can debilitate in the absence of adequate care1-2.

Changes that occur during the puerperal period may have metabolic, hormonal and emotional origins, which increases women's susceptibility to certain endogenous or exogenous problems. These complications include postpartum infection, postpartum depression, venous complications, breast and urinary infections, dyspareunia, puerperal hemorrhage, among others3-4.

Female genital tract infection, for example, is a type of postpartum condition that can spread systemically and compromise the functioning of the body, resulting in the death of the woman within a short period of time. Timely identification and treatment of complications such as this are essential to prevent seriousness and maternal death5-6 .

In 2019, the Maternal Mortality Ratio (MMR) was 57.9 per 100,000 live births in Brazil, of which 20% were due to hypertension, 12,4% to hemorrhage and 4,4% to puerperal infection. Almost all deaths were due to preventable causes, since the ways to prevent and control these diseases are already well understood and can be accessed through quality health services5-8 .

One of the attributes for the effectiveness of postpartum care is the longitudinality of health care, one of the attributes of Primary Health Care (PHC). PHC corresponds to the set of actions, at an individual and collective level, that promote the recognition of the population's needs and the resolution of approximately 80% of the health problems of the population assisted9-11 .

Postpartum care involves welcoming and addressing maternal needs, with a focus on preventing, promoting, protecting and treating women's health problems or conditions. To this end, the nurse and/or physician must perform at least two postpartum consultations within forty-two days after delivery, in order to assess maternal health, identify complications and provide guidance on reproductive planning, breastfeeding and newborn care5,9. However, despite what is expected, the frequency of postpartum consultations is significantly low in Brazil. In Botucatu, São Paulo, for example, the proportion of women who attend postpartum consultations is 58.3%. In Uberaba, Minas Gerais, this figure corresponds to 34.7%12,13.

In this context, research to identify the frequency and factors that hinder access to postpartum care is relevant for different Brazilian locations, as it can contribute to understanding different realities. Such knowledge can support the development and implementation of strategies to improve postpartum care for women.

This study aims to objective to investigate the frequency of postpartum consultations, and the factors associated with low adherence to follow-up among postpartum women living in a municipality in the interior of the Northeast.

 

Materials and Methods

This is a cross-sectional, quantitative, descriptive-analytical study. The research was carried out in Senhor do Bonfim, Bahia, Brazil, a municipality with an estimated population of 79,424 inhabitants in 2020 and a Municipal Human Development Index (MHDI) of 0,666, which corresponds to a medium-level classification14.

Women were recruited for the study based on records from the Live Birth Information System (SINASC) of women who gave birth between March and June 2019 (the time frame adopted for this analysis), resulting in a total of 180 women. The initial proposal was that all 180 women who gave birth in the period described above would be surveyed. However, there were 83 losses, resulting in a final number of 97 participants.

It is important to highlight that 54.30% (45) of these losses occurred due to inconsistencies found in SINASC (such as incomplete addresses), which made it impossible to locate them. As it is an important information system for the analysis of maternal and child health conditions, and since it is extremely important to correctly fill in information about live births, a second article was produced and published that discussed the quality of SINASC information based on the analysis of the data used in the present study15.

Regarding the other losses, 27.70% (23) occurred due to a change of address (it was not possible to obtain the address of the new place of residence), 9.60% (8) of the puerperal women were not found at home (even after three attempts to visit each) and 8.40% (7) due to refusal to participate.

The study included postpartum women living in the urban area of the municipality, who were monitored by both the public and private health services. The inclusion criteria adopted were: postpartum women aged 18 or over and who were between the third and sixth month postpartum.

The exclusion criteria considered were: birth resulting in stillbirth; neonatal death (immediate or late); death of the child up to the time of the survey, as recent trauma could result in response bias.

The form used to collect data was developed based on questions contained in a survey entitled “Prenatal Care on Your Cell Phone (PRENACEL)”, carried out with pregnant and postpartum women living in Ribeirão Preto – São Paulo16 and in a literature review on the subject. Before being used, the instrument was tested with ten women living in Senhor do Bonfim, who were postpartum and who were not part of the final study. Possible errors were then corrected, and the form was improved.

Five undergraduate nursing students from the Universidade do Estado da Bahia (UNEB) who received prior training participated in data collection. Data collection took place from June 2019 to January 2020 through interviews conducted during home visits.

Participants were informed about the objectives of the research, their voluntariness and the need for consent. Two copies of the Informed Consent Form were given and signed, one for the researcher and the other for the woman being interviewed. All participants who agreed to participate in the research participated in the study. The project was approved by the Research Ethics Committee (REC) in March 2019 under opinion number 3,212,217. The data and literature used for the theoretical basis of this study are freely available at Mendeley Data17.

The data collected was then double entered into the Statistical Package for the Social Science (SPSS) software version 22 and checked by comparing the two banks of simple frequencies of all variables. Thus, inconsistencies related to typing could be corrected and those related to filling in the data were considered as losses.

Initially, a descriptive analysis of the study was performed, based on the absolute and relative frequencies of the variables studied. Regarding the comparison analysis between groups, the outcome variable adopted was the completion of the “postpartum consultation”, categorized as having or not having attended the consultation. The independent variables were: sociodemographic, obstetric history and characteristics of prenatal care and current delivery.

For the bivariate analysis, the following were calculated: Odds Ratio (OR), 95% Confidence Interval (CI) and Pearson's Chi -square/Fisher's Exact Test, with an association considered when the p-value is less than 0.05.

Finally, an adjusted analysis was performed using Multiple Logistic Regression, with three types of models being calculated to verify which one best fit the proposed analysis: Model 1 - all independent variables were used for the analysis; Model 2 - Stepwise ; Model 3 - only those independent variables whose p-value of the Chi -square/Fisher's Exact test was less than 0.25 were included in the analysis. The best-fitting model for this analysis was Stepwise, but it is important to highlight that all three models found an association between the outcome variable and the same independent variables, which further reinforces the results obtained.

It is reiterated that this research was financed by the Bahia State Research Support Foundation (FAPESB), associated with the larger project entitled “Postpartum reproductive planning among women treated in Primary Care (PC) in Senhor do Bonfim – BA”18.

Strengthening (checklist was used. the Reporting of Observational Studies in Epidemiology)19.

 

Results

Regarding the sociodemographic characteristics of the 97 women surveyed, 75.20% were under 35 years of age, 80.40% self-identified as black or brown, 88.50% had eight or more years of schooling, 82.50% belonged to social classes C, D or E and 50.50% performed some type of paid activity. No associations were observed between the variables analyzed (Table 1).

 

Table 1. Sociodemographic characteristics of postpartum women in the municipality of Senhor do Bonfim-BA, 2019-2020

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Furthermore, about the puerperal consultation, 67.00% attended the postpartum consultation, and 73.80% attended only one appointment. Among the main reasons that justified non-adherence, 25.00% of puerperal women reported the lack of time to schedule the appointment, 18.80% mentioned the lack of time to go to the consultation and 15.60% stated a lack of interest in attending the unit (Table 2).

 

Table 2. Aspects of postpartum consultation among postpartum women in the municipality of Senhor do Bonfim-BA, 2019-2020

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Table 2. Aspects of postpartum consultation among postpartum women in the municipality of Senhor do Bonfim-BA, 2019-2020

Postpartum consultation Postpartum women
n %
She went to the appointment (n=97)
   Yes 65 67.00
   No 32 33.00
Number of appointments made (n=65)
   One appointment 48 73.80
   Two appointments 17 26.20
Reasons for not joining (n=32)
   Lack of time to make an appointment 08 25.00
   Lack of time to go to the appointment 06 18.80
   Not interested in going to the appointment 05 15.60
   She didn't know I had to go 03 9.40
   She didn't know when to go 01 3.10
   UBS does not offer follow-up 01 3.10
   Indisposition 01 3.10
   Others factors 07 21.90

 

According to the information on the pregnancy-puerperal period, 82.30% of participants had one to two previous pregnancies, 77.90% had seven or more prenatal appointment, of which 72.90% were in the Sistema Único de Saúde (SUS), 55.70% had a cesarean section and 60.80% received guidance on the importance of returning for the puerperal consultation during prenatal care. Regarding the association between the variables, it was observed that the chance of not having a puerperal consultation among women who did not schedule the consultation at the maternity hospital was 5.47 times higher compared to women who did schedule it (Table 3).

Regarding guidance during prenatal care about postpartum appointment, the chance of not attending postpartum follow-up is 2.89 times greater among those who did not receive the information compared to the chance among women who were guided during pregnancy. When analyzing the association between not attending postpartum consultations and the type of service where the woman received prenatal care, the chance of not returning for postpartum follow-up among puerperal women who received prenatal care through the SUS is 5.42 times greater than the chance among those who received care through private services (Table 3).

 

Table 3. Obstetric history, prenatal characteristics and current delivery of postpartum women in the municipality of Senhor do Bonfim-BA, 2019-2020

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Table 3. Obstetric history, prenatal characteristics and current delivery of postpartum women in the municipality of Senhor do Bonfim-BA, 2019-2020

Variables of pregnancy and childbirth Total n (%) Postpartum consultation OR (IC 95%) p-value1
Yes n(%) No n(%)
Pregnancies previous
   1-2 56 (82.30) 35 (79.50) 21 (87.50) 1
    ≥ 3 12 (17.70) 09 (20.50) 03 (12.50) 0.55 (0.13 – 2.28) 0.517
Current pregnancy planned
   Yes 51 (52.60) 36 (55.40) 15 (46.90) 1
   No 46 (47.40) 29 (44.60) 17 (53.10) 1.40 (0.60 – 3.28) 0.430
Prenatal in gestation current
   Yes 96 (99.00) 64 (98.50) 32 (100) * *
   No 01 (1.00) 01 (1.50) 0
Prenatal appointment
   ≤ 6 21 (22.10) 15 (23.80) 06 (18.80) 0.73 (0.25 – 2.13) 0.663
   ≥ 7 74 (77.90) 48 (76.20) 26 (81.20) 1
Scheduling of the postpartum appointment at the maternity hospital
    Yes 20 (21.30) 18 (28.10) 02 (6.70) 1
   No 74 (78.70) 46 (71.90) 28 (93.30) 5.47 (1.18 – 25.41) 0.028
Guidance in the PN on the postpartum appointment
    Yes 59 (60.80) 45 (69.20) 14 (43.80) 1
   No 38 (39.20) 20 (30.80) 18 (56.20) 2.89 (1.20 – 6.93) 0.015
Location of prenatal
    SUS** 70 (72.90) 41 (64.10) 29 (90.60) 5.42 (1.48 – 19.77) 0.006
    Private Service 26 (27.10) 23 (35.90) 03 (9.40) 1
Current birth route
   Vaginal 43 (44.30) 25 (38.50) 18 (56.30) 2.05 (0.87 – 4.85) 0.097
   Caesarean section 54 (55.70) 40 (61.50) 14 (43.70) 1

1 Value found using Pearson's Chi -square/Fisher's Exact Test. CI – Confidence Interval; OR – Odds Ratio; SUS – Brazilian National Health System; PN – Prenatal; * No OR or CI was calculated because there was only one person surveyed in one of the categories; **Consultation carried out in the Family Health Strategy or other public services.

 

The chance of not returning for the postpartum appointment among women who received prenatal care through the SUS is 0.05 in relation to the chance of those who received follow-up care in the private service. Among the puerperal women who did not receive guidance during prenatal care about postpartum follow-up, the chance of not attending the consultation is 0.20 in relation to those who received guidance (Table 4).

 

Table 4. Adjusted analysis of the variable’s location of the PN and guidance on the puerperal consultation in the municipality of Senhor do Bonfim-BA, 2019-2020

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Table 4. Adjusted analysis of the variable’s location of the PN and guidance on the puerperal consultation in the municipality of Senhor do Bonfim-BA, 2019-2020

Variables Model with all variables1 Stepwise Model2 Model variables p < 0.253
OR (95% CI) p OR (95% CI) p OR (95% CI) p
PN location
   SUS 0.05 (0.01-0.41) 0.007 0.08 (0.01-0.41) 0.002 0.12 (0.03-0.50) 0.004
   Private 1 1 1
Guidance on postpartum appointment
   Yes 1 1 1
   No 0.20 (0.06-0.62) 0.005 0.22 (0.08-0.63) 0.004 0.23 (0.08-0.64) 0.005

1 All independent variables were used for the analysis. 2 Stepwise. 3 Only those independent variables whose Chi -square/Fisher's exact p-value was less than 0.25 were included in the analysis. PN – Prenatal.

 

Discussion

In this study, we investigated the factors associated with low adherence to postpartum appointment among women in the interior of the Northeast, also listing the frequency of these consultations. The results show that prenatal care was carried out in a public network, the lack of guidance on the importance of returning for the postpartum appointment and the failure to schedule the consultation by the maternity hospital are factors that stand out as promoters of non-attendance at postpartum follow-up.

In this sense, regarding postpartum monitoring, Baratieri and Natal (2019) state that, according to the indicators of postpartum appointment, Brazil stands out as having low performance, with percentages ranging from 16.80% to 58.00%. However, Peru (in its 9 poorest regions) also had 58.00% of women who underwent postpartum monitoring, while in the United Kingdom the percentage reached 91.00% in six weeks postpartum. In Australia, the impasses referred to the lack of adherence to postpartum appointment were related to the lack of guidelines and protocols for care for the mother-child binomial20.

In the Northeast, a study indicates that the access variables that most influence adherence to postpartum appointment are the distance from the residence to UBS and information about the UBS's opening hours. A higher prevalence of consultations was identified for women who lived less than 16 minutes from the UBS. The fact that the woman knew the opening hours and the daily availability on five days a week was also able to increase the chance of attending the consultation by 1.3021.

The same study showed that sociodemographic variables also act as determinants, since women living in the South and Southeast were more likely to have a postpartum appointment, as were those with a high school diploma21.

Among the women interviewed in Senhor do Bonfim, 67.00% attended at least one postpartum follow-up appointment, a value similar to that found for the Northeast region, according to the National Base Study Nascer no Brasil (62.80%)22.

The aforementioned study also found that the frequency of return for at least one postpartum appointment in the country was 73.90%, and could vary from 57.20% (states that make up the North region) to 87.00% (South region)22.

In Brazil, there is no isolated indicator of minimum coverage recommended to be achieved in relation to the frequency of postpartum appointment according to the target audience, which shows the lack of prioritization by the state in relation to the monitoring of postpartum women.

Among the women interviewed in Senhor do Bonfim, 67.00% received health care after childbirth, a value similar to that found for the Northeast region, according to the study mentioned above (62.80%)22.

It is important to highlight that even though there are national protocols, states and municipalities can implement measures that improve postpartum care based on their respective realities, as is the case in Rio Grande do Sul with resolution 251 of 2018. This regulation includes, as one of the measures to guarantee monitoring during the pregnancy-puerperal cycle, at least one postpartum consultation up to the twentieth day postpartum23.

Another important result of this research was the fact that less than a third of the puerperal women who attended the first consultation returned for a second appointment. When searching for data regarding this return in other contexts, a lack of such information was observed, which reinforces the need to devote greater attention to postpartum care.

The HM recommends carrying out two postpartum consultations, one of which should be carried out in the first week after birth, preferably in the form of a home visit, and the other within forty-two days after childbirth1,24. Furthermore, it reinforces the need to identify the reasons of non-attendance, of actively searching for the absent puerperal woman and of offering a new day to the query5.

In this context, Community Health Agents (CHAs) play a fundamental role, being able to provide guidance on the importance of consultations, encourage return visits and strengthen the link between the health service and the woman25.

In addition, the health team can define strategies to increase adherence among postpartum women, such as providing alternative times for care at the unit and providing information about the possibility of taking the newborn to the outpatient clinic at the time of the consultation.

When mentioning the reasons that led to the non-performance of postpartum monitoring, almost half of the participants in the municipality surveyed mentioned issues related to lack of time. A qualitative study on the experiences of women in the postpartum period, carried out in the northwest of Paraná, pointed to the lack of time as one of the main difficulties encountered in the postpartum period, which can be justified by aspects such as the reduced support network and the social stereotype of the devoted maternal figure, of sacrifice, of donation and of exclusive dedication to the newborn26.

In a study carried out in the city of Uberaba, Minas Gerais, the main reasons given by postpartum women for not having attended the postpartum appointment were forgetfulness and the emergence of complications with the newborn13.

In the present analysis, an association was observed between prenatal care being carried out in the SUS and the puerperal woman not returning for the postpartum appointment. This result may be related to some aspects mentioned in the literature, such as the breakdown of the bond between the primary care professional and the user (due to the high turnover of health team members), the difficulty in obtaining care in the SUS and the long distance between the health unit and homes27,28.

Furthermore, it was noted that in the municipality studied there was a relationship between women not having been informed about the importance of postpartum monitoring during prenatal care and not having attended a postpartum appointment. A study carried out in 2019 showed the inadequacy of the guidance received by women during prenatal care as one of the problems found in primary care in the state of Santa Catarina29.

Health education is extremely important in all aspects of primary care, as it contributes to the prevention and reduction of injuries, diseases and complications. Scenarios in which the transfer of information in maternal care is unsatisfactory can result in a worsening of quality of life levels during pregnancy, childbirth and the postpartum period, and consequently in the risk to the maintenance of life30.

Maternal health care, therefore, should be seen as a line of care that goes from pre-conception monitoring to the postpartum period31. To this end, the professionals involved must promote longitudinal and uninterrupted care throughout all phases of the pregnancy-puerperal period.

The advantage of this study is that it analyzes in detail aspects related to the coverage of puerperal monitoring in the municipality's Primary Care, as these aspects are not included in the health information systems and are valuable information for local management in the search for improving the quality of maternal health care.

One limitation observed is the high percentage of losses due to data related to the identification of postpartum women in SINASC, which led to a significant reduction in the group to be researched.

 

Conclusion

A low frequency of postpartum appointment was observed among the women surveyed, with the main reason for non-attendance being the difficulty in going to the consultation due to lack of time. In addition, the lack of continuity of care after childbirth among women who received prenatal care in the SUS stands out, even though the primary care has an essential tool, the CHAs, who goes door to door and is the main actor in the active search for those who are absent.

Another important point was the limited use of health education to raise awareness among women about returning to the health service after giving birth, a worrying finding, as both individual and group education should be one of the foundations of the care offered by Family Health Teams in serving the community.

Failure to attend postpartum appointments has significant impacts on the health of the mother-child pair. In addition to compromising the monitoring of conditions identified during pregnancy, which may worsen or become chronic, it also interferes with adherence to reproductive planning and childcare consultations and compliance with the child's vaccination schedule. Studies such as this one, which identify these gaps, are essential for the development of strategies that promote the bond between the patient and the primary care health team. These strategies include educational measures on the importance of continuity of care in the postpartum period, encouraging active search and recruitment of women who are absent, as well as training professionals responsible for increasing adherence to postpartum appointment, contributing, in the long term, to improving public health.

Thus, it is expected that the gaps highlighted by this study will serve as a basis for formulating strategies that increase the coverage and quality of postpartum appointment, with the aim of maintaining longitudinal care even after childbirth.

Conflicts of Interest: The authors declare that they have no conflict of interest in any aspect for the publication of the article.

Financing: Research funded by the Bahia State Research Support Foundation (FAPESB), associated with the project entitled “Postpartum reproductive planning among women receiving primary care in Senhor do Bonfim – BA”.

 

References

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Mascarello KC, Matijasevich A, Santos I da S dos, Silveira MF. Complicações puerperais precoces e tardias associadas à via de parto em uma coorte no Brasil. Rev bras epidemiol 2018;21:e180010. https://doi.org/10.1590/1980-549720180010

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Fundação Oswaldo Cruz- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Portal de Boas Práticas em Saúde da Mulher, da Criança e do Adolescente. Postagens: A Consulta Puerperal na Atenção Primária à Saúde. Rio de Janeiro, 2020. Consulta: Abril 06, 2022. Disponível em: https://portaldeboaspraticas.iff.fiocruz.br/atencao-mulher/a-consulta-puerperal-na-atencao-primaria-a-saude

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FIOCRUZ. Tendências da mortalidade materna 2000-2020. 2023. Consulta: Abril 20, 2024. Disponível em: https://portaldeboaspraticas.iff.fiocruz.br/atencao-mulher/tendencias-na-mortalidade-materna-2000-2020/

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Secretaria de vigilância em Saúde. Ministério da Saúde. Boletim Epidemiológico - Mortalidade Proporcional por Grupos de Causas em Mulheres no Brasil em 2010 e 2019. 2021. Consulta: Maio 1,2024. Disponível em: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/boletins/epidemiologicos/edicoes/2021/boletim_epidemiologico_svs_29.pdf

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Oliveira EFP, Araújo Filho VM, Gonçalves HR, Fonseca KF, Garcia PS, Reis RB, et al. Razão de Mortalidade Materna (RMM) no Brasil, 2012 – 2021. Braz J Surg Clin Res. 2023;43(3):5-9. https://www.mastereditora.com.br/periodico/20230804_170550.pdf

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Ministério da Saúde. Portaria n. 648 de março de 2006. Aprova a Política Nacional de Atenção Básica, estabelecendo a revisão das diretrizes e normas para organização da Atenção Básica do Programa Saúde da Família (PSF) e do Programa Agentes Comunitários de Saúde (PACS). Brasília; 2006. Consulta: Abril 28, 2024. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/prtGM648_20060328.pdf

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Starfield B. Atenção Primária: Equilibrando Necessidades, Serviços e Tecnologia de Saúde. Brasília: ONU/Ministério da Saúde; 2002.Disponível em: Atenção primária: equilíbrio entre necessidades de saúde, serviços e tecnologia - UNESCO Digital Library.

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Organização Pan-Americana da Saúde. Atenção primária à saúde. 2024. Consulta: Abril 28, 2024. Disponível em: https://www.paho.org/pt/topicos/atencao-primaria-saude

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Oliveira RLA de, Ferrari AP, Parada CMG de L. Processo e resultado do cuidado pré-natal segundo os modelos de atenção primária: um estudo de coorte. Rev Lat Am Enfermagem. 2019;27:e3058. http://dx.doi.org/10.1590/1518-8345.2806.3058

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Pinto IR, Martins VE, Oliveira JF de, Oliveira KF de, Paschoini MC, Ruiz MT. Adesão à consulta puerperal: facilitadores e barreiras. Esc Anna Nery. 2021; 25(2):e20200249. http://dx.doi.org/10.1590/2177-9465-ean-2020-0249

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IBGE. Senhor do Bonfim [Internet]. 2019. Consulta: Abril 28, 2024. Disponível em: https://cidades.ibge.gov.br/brasil/ba/senhor-do-bonfim/panorama

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Almeida SR de, Santos CVR dos, Martins MRL da S, Fraga CD de, Andrade MS. Inconsistências nos dados do Sistema de Informação sobre Nascidos Vivos (SINASC). Revista DELOS. 2024;17(60):01-16. https://doi.org/10.55905/rdelosv17.n60-130

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Oliveira-Ciabati L, Vieira CS, Franzon ACA, Alves D, Zaratini FS, Braga GC, et al. PRENACEL – a mHealth messaging system to complement antenatal care: a cluster randomized trial. Reprod Health. 2017;14(1):1-12. https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-017-0407-1

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De Amorim ALM, Fraga CD de S; Rocha TNA, Lira KKA dos S, Andrade MS. Fatores associados à não realização da consulta puerperal: um estudo transversal. Mendeley Data V1. 2024. https://doi.org/10.17632/ddwhcyndbn.1

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Martins RLS, Cunha VMG da, Santos MC, Silva FLB, Bispo EMP, Fraga CDS, et al. Planejamento reprodutivo no período pós-parto entre mulheres atendidas na atenção primária. Rev Saúde Col UEFS. 2023;13(1):e8532. https://doi.org/10.13102/rscdauefs.v13i1.8532

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STROBE. STROBE Checklists. Consulta: Junho 30, 2024. Disponível em: https://www.strobe-statement.org/checklists/

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Bartieri T, Natal S. Ações do programa de puerpério na atenção primária: uma revisão integrativa. Ciência & Saúde Coletiva, 2019;24(11):4227-4238. https://doi.org/10.1590/1413-812320182411.28112017

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Bartieri T, Chaves ACP, de Oliveira IB, Pelazza BB, Lentsck MH, Sangaleti CT, et al. Fatores de acesso associados à adesão à consulta pós-parto na atenção primária à saúde. Rev. Contexto & Saúde, 2024;24(48): e14651. http://dx.doi.org/10.21527/2176-7114.2024.48.14651

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Domingues RMSM, Dias BAS, Bittencourt SD de A, Dias MAB, Torres JA, Cunha EM da, et. al. Utilização de serviços ambulatoriais de saúde por puérperas e recém-nascidos: dados do estudo Nascer no Brasil. Cad Saúde Pública. 2020;36(5):1-17. https://doi.org/10.1590/0102-311X00119519

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Secretaria da Saúde Estado do Rio Grande do Sul. Lei n° 251/18– CIB/RS. Aprova a Nota Técnica sobre assistência pré-natal na atenção básica no Rio Grande do Sul, conforme Anexo desta Resolução. 2018. Consulta: Maio 15, 2024. Disponível em: https://saude.rs.gov.br/upload/arquivos/carga20180743/18164307-cibr251-18.pdf

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Ministério da Saúde. Agenda de compromissos para a saúde integral da criança e redução da mortalidade infantil. Brasília 2004. Consulta: Maio 15, 2024. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/agenda_compro_crianca.pdf

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Baratieri T, Lentsck MH, Falavina LP, Soares LG, Prezotto KH, Pitilin EB. Longitudinalidade do cuidado: fatores associados à adesão à consulta puerperal segundo dados do PMAQ-AB. Cad Saúde Pública. 2022;38(3):e00103221. https://doi.org/10.1590/0102-311X00103221

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Referencias

Kolln Genero I, Reis dos Santos K. Vivências de mulheres sobre o processo de parturição e pós-parto em um hospital escola. Revista Psicologia, Diversidade e Saúde. 2020;9(3):261-79. http://dx.doi.org/10.17267/2317-3394rpds.v9i3.2915

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Mendes RB, Santos JM de J, Prado DS, Gurgel RQ, Bezerra FD, Gurgel RQ. Avaliação da qualidade da assistência pré-natal com base nas recomendações do Programa de Humanização do Pré-natal e Nascimento. Ciência Saúde Coletiva. 2020;25(3):793-804. https://doi.org/10.1590/1413-81232020253.13182018

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Vieira NFC, Machado M de FAS, Nogueira PSF, Lopes K de S, Vieira-Meyer APGF, Morais APP, et al. Fatores que influenciam a satisfação do usuário com a Atenção Primária à Saúde. Interface (Botucatu). 2021;25:e200516. https://doi.org/10.1590/interface.200516

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Marques BL, Tomasi YT, Saraiva S dos S, Boing AF, Geremia DS. Orientações à gestante: a importância do cuidado compartilhado na atenção primária à saúde. Esc Anna Nery. 2021;25(1):e20200098. https://doi.org/10.1590/2177-9465-EAN-2020-0098

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Cavalcanti LM de B, Sousa MNA de. Educação em saúde na Atenção Primária durante o ciclo gravídico-puerperal: Uma revisão integrativa. Research, Society and Developmen. 2021;10(5):e18010514662. https://doi.org/10.33448/rsd-v10i5.14662

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Secretaria de Estado da Saúde/RJ. Atenção ao Pré-Natal: Rotinas para Gestantes de Baixo Risco. Rio de Janeiro; 2019. Consulta: Maio 17, 2024. Disponível em: https://subpav.org/SAP/protocolos/arquivos/guia_de_referencia_rapida_atencao_ao_pre-natal__:rotinas_para_gestantes_de_risco_habitual__.pdf

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  1. Secretaria de Estado da Saúde do Rio Grande do Sul. Guia do pré-natal na atenção básica Porto Alegre. Secretaria Estadual de Saúde/RS 2018. Consulta: Maio 16, 2024 Disponível em: https://portaldeboaspraticas.iff.fiocruz.br/wp-content/uploads/2020/11/09090527-guia-pre-natal-na-atencao-basica-web.pdf

  2. Organização Pan-Americana da Saúde (OPAS). Organização Mundial da Saúde (OMS). Apelo por cuidados de qualidade para mulheres e recém-nascidos nas primeiras semanas cruciais após o parto. 2022. Consulta: Abril 19, 2024. Disponível em: https://www.paho.org/pt/noticias/30-3-2022-oms-pede-atencao-qualidade-para-mulheres-e-recem-nascidos-nas-primeiras-semanas

  3. Teixeira PC, Simões MMD, Santanna GS, Teixeira NA, Koeppe GB, Cerqueira LCN. Cuidados de enfermagem no período pós-parto: Um enfoque na atuação do enfermeiro diante as complicações puerperais. Rev. Nursing. 2019; 22(259):3436-446. https://www.revistanursing.com.br/index.php/revistanursing/article/view/452/426

  4. Mascarello KC, Matijasevich A, Santos I da S dos, Silveira MF. Complicações puerperais precoces e tardias associadas à via de parto em uma coorte no Brasil. Rev bras epidemiol 2018;21:e180010. https://doi.org/10.1590/1980-549720180010

  5. Fundação Oswaldo Cruz- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Portal de Boas Práticas em Saúde da Mulher, da Criança e do Adolescente. Postagens: A Consulta Puerperal na Atenção Primária à Saúde. Rio de Janeiro, 2020. Consulta: Abril 06, 2022. Disponível em: https://portaldeboaspraticas.iff.fiocruz.br/atencao-mulher/a-consulta-puerperal-na-atencao-primaria-a-saude

  6. FIOCRUZ. Tendências da mortalidade materna 2000-2020. 2023. Consulta: Abril 20, 2024. Disponível em: https://portaldeboaspraticas.iff.fiocruz.br/atencao-mulher/tendencias-na-mortalidade-materna-2000-2020/

  7. Secretaria de vigilância em Saúde. Ministério da Saúde. Boletim Epidemiológico - Mortalidade Proporcional por Grupos de Causas em Mulheres no Brasil em 2010 e 2019. 2021. Consulta: Maio 1,2024. Disponível em: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/boletins/epidemiologicos/edicoes/2021/boletim_epidemiologico_svs_29.pdf

  8. Oliveira EFP, Araújo Filho VM, Gonçalves HR, Fonseca KF, Garcia PS, Reis RB, et al. Razão de Mortalidade Materna (RMM) no Brasil, 2012 – 2021. Braz J Surg Clin Res. 2023;43(3):5-9. https://www.mastereditora.com.br/periodico/20230804_170550.pdf

  9. Ministério da Saúde. Portaria n. 648 de março de 2006. Aprova a Política Nacional de Atenção Básica, estabelecendo a revisão das diretrizes e normas para organização da Atenção Básica do Programa Saúde da Família (PSF) e do Programa Agentes Comunitários de Saúde (PACS). Brasília; 2006. Consulta: Abril 28, 2024. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/prtGM648_20060328.pdf

  10. Starfield B. Atenção Primária: Equilibrando Necessidades, Serviços e Tecnologia de Saúde. Brasília: ONU/Ministério da Saúde; 2002.Disponível em: Atenção primária: equilíbrio entre necessidades de saúde, serviços e tecnologia - UNESCO Digital Library.

  11. Organização Pan-Americana da Saúde. Atenção primária à saúde. 2024. Consulta: Abril 28, 2024. Disponível em: https://www.paho.org/pt/topicos/atencao-primaria-saude

  12. Oliveira RLA de, Ferrari AP, Parada CMG de L. Processo e resultado do cuidado pré-natal segundo os modelos de atenção primária: um estudo de coorte. Rev Lat Am Enfermagem. 2019;27:e3058. http://dx.doi.org/10.1590/1518-8345.2806.3058

  13. Pinto IR, Martins VE, Oliveira JF de, Oliveira KF de, Paschoini MC, Ruiz MT. Adesão à consulta puerperal: facilitadores e barreiras. Esc Anna Nery. 2021; 25(2):e20200249. http://dx.doi.org/10.1590/2177-9465-ean-2020-0249

  14. IBGE. Senhor do Bonfim [Internet]. 2019. Consulta: Abril 28, 2024. Disponível em: https://cidades.ibge.gov.br/brasil/ba/senhor-do-bonfim/panorama

  15. Almeida SR de, Santos CVR dos, Martins MRL da S, Fraga CD de, Andrade MS. Inconsistências nos dados do Sistema de Informação sobre Nascidos Vivos (SINASC). Revista DELOS. 2024;17(60):01-16. https://doi.org/10.55905/rdelosv17.n60-130

  16. Oliveira-Ciabati L, Vieira CS, Franzon ACA, Alves D, Zaratini FS, Braga GC, et al. PRENACEL – a mHealth messaging system to complement antenatal care: a cluster randomized trial. Reprod Health. 2017;14(1):1-12. https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-017-0407-1

  17. De Amorim ALM, Fraga CD de S; Rocha TNA, Lira KKA dos S, Andrade MS. Fatores associados à não realização da consulta puerperal: um estudo transversal. Mendeley Data V1. 2024. https://doi.org/10.17632/ddwhcyndbn.1

  18. Martins RLS, Cunha VMG da, Santos MC, Silva FLB, Bispo EMP, Fraga CDS, et al. Planejamento reprodutivo no período pós-parto entre mulheres atendidas na atenção primária. Rev Saúde Col UEFS. 2023;13(1):e8532. https://doi.org/10.13102/rscdauefs.v13i1.8532

  19. STROBE. STROBE Checklists. Consulta: Junho 30, 2024. Disponível em: https://www.strobe-statement.org/checklists/

  20. Bartieri T, Natal S. Ações do programa de puerpério na atenção primária: uma revisão integrativa. Ciência & Saúde Coletiva, 2019;24(11):4227-4238. https://doi.org/10.1590/1413-812320182411.28112017

  21. Bartieri T, Chaves ACP, de Oliveira IB, Pelazza BB, Lentsck MH, Sangaleti CT, et al. Fatores de acesso associados à adesão à consulta pós-parto na atenção primária à saúde. Rev. Contexto & Saúde, 2024;24(48): e14651. http://dx.doi.org/10.21527/2176-7114.2024.48.14651

  22. Domingues RMSM, Dias BAS, Bittencourt SD de A, Dias MAB, Torres JA, Cunha EM da, et. al. Utilização de serviços ambulatoriais de saúde por puérperas e recém-nascidos: dados do estudo Nascer no Brasil. Cad Saúde Pública. 2020;36(5):1-17. https://doi.org/10.1590/0102-311X00119519

  23. Secretaria da Saúde Estado do Rio Grande do Sul. Lei n° 251/18– CIB/RS. Aprova a Nota Técnica sobre assistência pré-natal na atenção básica no Rio Grande do Sul, conforme Anexo desta Resolução. 2018. Consulta: Maio 15, 2024. Disponível em: https://saude.rs.gov.br/upload/arquivos/carga20180743/18164307-cibr251-18.pdf

  24. Ministério da Saúde. Agenda de compromissos para a saúde integral da criança e redução da mortalidade infantil. Brasília 2004. Consulta: Maio 15, 2024. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/agenda_compro_crianca.pdf

  25. Baratieri T, Lentsck MH, Falavina LP, Soares LG, Prezotto KH, Pitilin EB. Longitudinalidade do cuidado: fatores associados à adesão à consulta puerperal segundo dados do PMAQ-AB. Cad Saúde Pública. 2022;38(3):e00103221. https://doi.org/10.1590/0102-311X00103221

  26. Kolln Genero I, Reis dos Santos K. Vivências de mulheres sobre o processo de parturição e pós-parto em um hospital escola. Revista Psicologia, Diversidade e Saúde. 2020;9(3):261-79. http://dx.doi.org/10.17267/2317-3394rpds.v9i3.2915

  27. Mendes RB, Santos JM de J, Prado DS, Gurgel RQ, Bezerra FD, Gurgel RQ. Avaliação da qualidade da assistência pré-natal com base nas recomendações do Programa de Humanização do Pré-natal e Nascimento. Ciência Saúde Coletiva. 2020;25(3):793-804. https://doi.org/10.1590/1413-81232020253.13182018

  28. Vieira NFC, Machado M de FAS, Nogueira PSF, Lopes K de S, Vieira-Meyer APGF, Morais APP, et al. Fatores que influenciam a satisfação do usuário com a Atenção Primária à Saúde. Interface (Botucatu). 2021;25:e200516. https://doi.org/10.1590/interface.200516

  29. Marques BL, Tomasi YT, Saraiva S dos S, Boing AF, Geremia DS. Orientações à gestante: a importância do cuidado compartilhado na atenção primária à saúde. Esc Anna Nery. 2021;25(1):e20200098. https://doi.org/10.1590/2177-9465-EAN-2020-0098

  30. Cavalcanti LM de B, Sousa MNA de. Educação em saúde na Atenção Primária durante o ciclo gravídico-puerperal: Uma revisão integrativa. Research, Society and Developmen. 2021;10(5):e18010514662. https://doi.org/10.33448/rsd-v10i5.14662

  31. Secretaria de Estado da Saúde/RJ. Atenção ao Pré-Natal: Rotinas para Gestantes de Baixo Risco. Rio de Janeiro; 2019. Consulta: Maio 17, 2024. Disponível em: https://subpav.org/SAP/protocolos/arquivos/guia_de_referencia_rapida_atencao_ao_pre-natal__:rotinas_para_gestantes_de_risco_habitual__.pdf