Social inequalities in perinatal mortality in Belo Horizonte, Brazil: The role of hospital care

Objectives. We examined the contribution of hospital type and quality of care to perinatal mortality rates in the city of Belo Horizonte, Brazil. Methods. We used a cohort study of all births (40953) and perinatal deaths (826) in Belo Horizonte in 1999. After adjusting for maternal education and birthweight, we compared mortality rates according to hospital category-defined by a hospital's relation to the national Universal Public Health System (SUS)-and quality of care. We used the Wigglesworth Classification to examine perinatal deaths. Results. After we controlled for birthweight and maternal education, the highest perinatal death rates were observed in private and philanthropic SUS-contracted hospitals relative to private, non-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. Conclusions. In a class-segregated health care system, such as Brazil's, disparities in quality of care between SUS-contracted and non-SUS-contracted hospitals contribute to the unacceptably high rates of perinatal mortality.