Geographic accessibility to hospital childbirths in Brazil (2010-2011 and 2018-2019): a cross-sectional study.

Background: Delays in obstetric care are associated with adverse maternal outcomes, while long-distance travel for delivery is associated with high neonatal mortality and increased maternal morbidity. Distance and travel time are key components of geographic accessibility to health services and important risk indicators for maternal and neonatal care. This study evaluated whether the Brazilian Unified Health System (SUS) has been geographically accessible in providing hospital childbirth services, over time. Methods: Geographic accessibility to hospital deliveries in Brazil was mapped over two biennia (2010-2011 and 2018-2019), spanning a 10-year period, using national aggregated data from SUS Hospital Admissions Authorizations. Travel flows, distances, and times between women's municipalities of residence and hospitals were estimated. Findings: A total of 6,930,944 hospital deliveries were analyzed. Overall, 25.4% (n = 1,759,306) of pregnant women traveled outside their municipalities to give birth in SUS hospitals, increasing from 23.6% (n = 843,501) in 2010-2011 to 27.3% (n = 915,805) in 2018-2019. Distance and travel time rose by 31.1% (54.0 km-70.8 km) and 33.6% (63.1-84.3 min), respectively. Women experiencing maternal and/or neonatal death traveled longer distances and times. Regional disparities were evident: the Northeast had the highest proportion of women traveling (35.6%; n = 817,499), and the North had the lowest (16.0%; n = 138,295). Women in the North faced the longest travel distances (97.5-133.4 km) and times (1,012-1,850 min), while those in the Southeast and South experienced the shortest distances (37.2-55.9 km and 41.2-54.8 km, respectively) and times (38-52 min and 41-52 min). Interpretation: The results highlight regional disparities in maternal health service access within the SUS, which may affect maternal and neonatal outcomes. Targeted public health measures are needed to improve the availability of service, particularly in the North and Northeast regions, where access issues are most severe. Funding: Fundação Oswaldo Cruz; CNPq; FAPERJ.