Being an interior municipality is sometimes good, sometimes bad: Management and prenatal care in small and medium sized municipalities

Abstract

This article aims to analyze the intersections in prenatal care and management in the Northwest Region of the State of Rio de Janeiro (RNERJ). This is a qualitative and quantitative case study conducted between July 2022 and February 2023, involving four municipalities chosen by convenience. Thirteen health professionals participated, six managers, four nurses, and three doctors. Quantitative data were collected using DATASUS and SISAB indicators. Qualitative data were produced through semi-structured interviews and field diary records. The analysis was guided by two analytical categories: prenatal care quality indicators and intersections in care practice and management. The results indicate that, despite the efforts of professionals, prenatal care in the region faces significant challenges, such as lack of structure and political interference, in addition to difficulties in implementing health policies and programs. Geographic proximity and community ties were identified as positive points, but the implementation of educational actions and early recruitment of pregnant women are still limited. We conclude that the organization of services must consider local specificities to reduce inequalities and promote more equitable and effective care.