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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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Health 2013年第12期5卷 1954-1964页

作者： Isabel Craveiro Paulo Ferrinho Bruno de Sousa luzia goncalves Unidade de Saude Publica Internacional e Bioestatistica Centro de Malaria e Outras Doencas TropicaisInstituto de Higiene e Me-dicina TropicalUniversidade Nova de LisboaLisbonPortugal Faculdade de Psicologia e de Ciencias da Educacao Universidade de CoimbraCentro de Investigacao do Nucleo de Estudos e In-tervencao Cognitivo-ComportamentalCoimbraPortugal Unidade de Saude Publica Internacional e Bioestatistica Instituto de Higiene e Medicina TropicalUniversidade Nova de Lisboa and CEAULLisbonPortugal

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

关键词： Women Poverty Access to Reproductive Health Care

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