Outline of adequacy of ANC and content of care. For analyses of adequacy and content of ANC, three measurements were considered. 1. Adequacy of the number of ANC visits adjusted to gestational age– seven visits or more when gestational age was equal to or more than 37 weeks was deemed adequate. For gestational age less than 37 weeks, the number of expected ANC visits was adjusted by gestational age; 2. The modified Kessner Index– defined according to the number of ANC visits and the initiation of ANC, according to the Brazilian proposal in the PPBH [12, 23, 33]. ANC was deemed adequate when 100% of expected visits were attended and ANC began by 17 weeks gestation, while ANC was deemed inadequate when less than 100% of expected visits were attended or ANC began after 17 weeks gestation; 3. The ANC laboratory studies and exams summary measure. Adequacy based on PPBH and Municipal Protocol [12, 14]. ANC was considered adequate when all three criteria were met, and inadequate when any one of the three criteria was not met.