Preventable perinatal mortality in Belo Horizonte, 1999: Social inequalities and the role of hospital care

We evaluate the quality of hospital perinatal care in Belo Horizonte, with the intent to suggest measures to improve the health care system and reduce the inequalities in infant and perinatal mortality. We used a cohort study of all births (40953) and perinatal deaths (826) in Belo Horizonte in 1999. Inequalities in perinatal mortality rates were analyzed among the hospitals according to their relation with the Unified Health Care System (SUS) and a quality of care score.  Multilevel regression analysis was carried out to identify the contribution of factors related to the hospital category (contextual factors) and individual factors (client characteristics) on the difference in the observed rates.  The Wigglesworth Classification was used to examine the preventability of perinatal deaths.  After we controlled for birthweight and maternal education, the highest perinatal death rates were observed in private and philanthropic SUS contracted hospitals. Hospital quality was also directly associated with perinatal death rates. Mortality rates were especially high for normal-birthweight babies born in private SUS-contracted hospitals.  Intrapartum asphyxia was the leading cause of preventable death. After controlling for individual characteristics, there was still a significant variation in perinatal deaths between hospitals categories. It was observed a class-segregated health care system, where disparities in preventable perinatal mortality among the SUS-contracted and non-SUS-contracted hospitals contribute to the unacceptably high rates of perinatal mortality. Independent of compositional (or individual) characteristics, hospital factors exert an influence on the risk of perinatal death, primarily hospital category related to SUS. Considering the highest proportion of births in SUS hospitals in Brazil, especially private-SUS hospitals, improving hospital quality of care is an urgent priority for reducing the toll of perinatal and infant mortality, as well as inequalities in these outcomes.