Mortalidad infantil y acceso geogr??fico al parto en los municipios brasile??os

OBJETIVO: Analisar o acesso geogr??fico ao parto hospitalar nos munic??pios brasileiros. M??TODOS: Foram analisadas informa????es de ??bitos e nascimentos quanto ?? sua adequa????o para o c??lculo do coeficiente de mortalidade infantil no per??odo de 2005 a 2007 para os 5.564 munic??pios brasileiros. O acesso geogr??fico foi expresso por indicadores de deslocamento, oferta e acesso aos servi??os de sa??de. A associa????o entre o acesso geogr??fico ao parto e o coeficiente de mortalidade infantil em munic??pios com adequa????o de suas informa????es vitais foi avaliada por meio de regress??o m??ltipla. RESULTADOS: Dentre os munic??pios analisados, 56% apresentaram adequa????o das informa????es vitais, correspondendo a 72% da popula????o brasileira. O deslocamento geogr??fico ao parto mostrou-se inversamente associado ao porte populacional, ?? renda per capita, e ?? mortalidade infantil, mesmo controlado por fatores demogr??ficos e socioecon??micos. CONCLUS??ES: Embora tenham sido desenvolvidas estrat??gias importantes para a melhoria da qualidade do atendimento ??s gestantes no Brasil, as a????es para garantir o acesso igualit??rio ?? assist??ncia ao parto ainda s??o insuficientes. O maior deslocamento intermunicipal para o parto se mostrou como um fator de risco para a mortalidade infantil, aliado ?? desigualdade de oferta de servi??os qualificados e ?? falta de integra????o com a aten????o b??sica de sa??deOBJECTIVE: To analyze geographic access to hospital childbirth in Brazilian municipalities. METHODS: Information on deaths and births were analyzed in regards to appropriateness for calculating the infant mortality rate during the period 2005 to 2007, for the 5,564 Brazilian municipalities. Indicators of supply and geographic access to health services were calculated to express hospital childbirth access. A multivariate regression model was used to test the association between geographic access to childbirth and the infant mortality rate in municipalities with adequate vital information. RESULTS: Of the municipalities analyzed, 56% had adequate vital information, corresponding to 72% of Brazil's population. The geographic distance between the municipality of residence and municipality of hospitalization was inversely associated to population size, per capita income and the infant mortality rate, even when controlling for demographic and socioeconomic factors. CONCLUSIONS: Although important strategies have been developed in Brazil to improve the quality of care for pregnant women, actions to guarantee equal access to childbirth services are still insufficient. Large geographic distance to childbirth facility was identified as a risk factor for infant mortality, together with unequal supply of quality health services and lack of integration with primary car