Dados do Trabalho

Title

Brazil in the world picture of maternal mortality and setback caused by the COVID-19 pandemic through a literature review

Objective

This work aims to conduct a literature review, focusing on Brazil in the global context of maternal mortality and the setback caused by the COVID-19 pandemic.

Methods

The research was carried out using the electronic databases PubMed, SciElo, and PAHO, with publications between the years 2017 and 2022, as well as bulletins and reports obtained from DATASUS, the Brazilian Obstetric Observatory, and the Pan American Health Organization. Articles, reports, and bulletins addressing aspects related to maternal mortality, its causes, and progress in Brazil were selected.

Results

The high rate of maternal mortality in the modern world is unacceptable, considering that most maternal deaths are preventable. The World Health Organization (WHO) and the United Nations (UN) have been working together with international agencies to establish ways to promote the reduction of causes and their impact on women's health, aiming at achieving the Sustainable Development Goals (SDGs) (Sociedade Beneficente Israelita Brasileira Albert Einstein, 2019).
The main complications, accounting for almost 75% of all maternal deaths, include hypertension (pre-eclampsia and eclampsia), severe hemorrhages, and infections, particularly postpartum infections, as well as complications during childbirth and unsafe abortions (OPAS, 2020).
Diseases like pre-eclampsia are among the most common pregnancy complications, and pregnant women with COVID-19 may have a higher likelihood of developing pre-eclampsia. This condition can lead to serious complications for both the mother and the fetus, such as renal and hepatic failure, premature placental abruption, and fetal death. Its incidence varies from 2% to 8% of pregnancies worldwide, responsible for about 14% of maternal deaths and 10% of fetal deaths (STEVENS, 2018; KHALIL, 2019; Di Mascio, 2020).
During the COVID-19 pandemic, there was a 94% increase in maternal mortality in Brazil, pushing mortality rates back to levels seen two decades ago, as revealed by the United Nations Population Fund. Between 2000 and 2020, the global maternal mortality ratio decreased by 34.3% [WHO, UNICEF, UNFPA, 2021]. In Latin America, between 1990 and 2015, maternal mortality decreased by 16.4%, but from 2016 to 2020, there was a 15% increase. In 2022, the maternal mortality rate in Latin America and the Caribbean was 68 per 100,000 live births. Preliminary data from the Brazilian Obstetric Observatory indicate that Brazil had 1,252 maternal deaths in 2022, translating to a rate of 50.6 deaths per 100,000 births (WHO 2022).
The investigation of women of childbearing age (WCBA) deaths is one of the strategies used for maternal death surveillance, allowing the identification of unreported maternal deaths. Through this indicator, the total number of maternal deaths has been decreasing over the past decades, but starting in 2020, there has been an increase in the number of maternal deaths. It increased from 62,035 total maternal deaths in 2018, 62,683 in 2019, 71,879 in 2020, 94,826 in 2021, to 66,862 in 2022, as demonstrated by the Mortality Information System (SIM, 2023).
Ministry of Health data and mappings showed that in Brazil, in 2016, the maternal mortality rate reached 64.4 per 100,000 live births. In 2017, it was 64.5; in 2018, it was 59.1; in 2019, the rate was 57.9; in 2020, it was 74.7, and in 2021, the rate was 117.4 per 100,000 live births. In 2021, during the pandemic, the mortality rate reached values similar to those seen in 1998 when the rate was 110.2 deaths (SIM, 2023).

Conclusion

Maternal mortality rate was on a declining trend due to various strategies aimed at improving women's health quality. Despite the COVID-19 pandemic, there are national and international perspectives for strengthening policies and actions to emphasize the importance of prenatal care in preventing pregnancy-related problems.

Keywords

Maternal mortality; Brazilian maternal mortality; maternal mortality rate