Social Inequalities and Gestational Risk in Rural and Urban Women: A Systematic Review of Literature
Maternal health reflects social equity and remains strongly influenced by the Social Determinants of Health (SDH), particularly in rural and low-resource settings. The objective was to describe social inequalities and their effect on pregnancy risk. This systematic review, conducted under PRISMA 2020 guidelines. The databases were PubMed, Scopus, and ScienceDirect. The synthesis of evidence reveals a direct correlation between the poverty index and the severity of complications. In various Latin American and middle-income country contexts, the maternal mortality ratio reached 75.19 per 1,000 live births, exceeding the national average, with critical vulnerability among women over 40 years of age (Ratio: 165.75). Although urban areas report a higher number of cases (251 vs. 165), rural areas face greater barriers related to the "third delay" (transportation and referral). The cost of care for severe preeclampsia (USD 827) acts as an impoverishment factor for low-income families, exacerbating the cycle of inequality. Social inequalities are not only geographical, but also structural and economic. A differentiated public policy is needed to mitigate the access gap in sparsely populated rural areas in order to effectively reduce maternal morbidity and mortality in the department.