Objective: To develop and apply a new instrument to evaluate prenatal care based on the guidelines of the Brazilian Humanization Program for Prenatal Care and Birth, including quantitative and qualitative elements distributed according to the evaluation triad of structure, process, and outcomes.
Methods: An analytic, descriptive, quantitative cross-sectional study was carried out with 238 women receiving care in 44 primary care services in the city of João Pessoa, Northeast Brazil, between November 2010 and December 2011. Physicians and nurses involved in prenatal care were also interviewed. The instrument developed by the investigators contains 23 questions relating to structure, process and outcomes of pre-natal care. Based on the information collected, pre-natal care was classified according to an IPR/Pre-Natal index (Índice IPR/Pré-Natal, where I stands for infrastructure, P for work process and R for results). A value of 1 is attributed to each question if it complies with the criteria established for quality, or 2 if it does not comply. The percent of adequate answers in relation to the 23 total questions is used to classify prenatal care as: upper adequate (100% adequate answers); adequate (>75%); intermediate (51 to 74%); and inadequate (<50%). The classification categories for the Pre-Natal/IPR index were compared to those of the Kessner and Adequacy of Prenatal Care Utilization (APNCU) indices.
Results: Questions relating to the work process contributed significantly to the classification of prenatal care as intermediate according to the IPR/Pre-Natal. IPR/Pre-Natal classification categories were consistent to detect prematurity, insufficient weight at birth and absence of exclusive breastfeeding.
Conclusions: The IPR/Pre-Natal index effectively incorporated quantitative and qualitative elements for the assessment of pre-natal care.