Trends and epidemiological profile of maternal deaths in Brazil from 2000 to 2022

Abstract

Objective: To analyze trends and the epidemiological profile of maternal deaths in Brazil from 2000 to 2022. Method: This ecological time-series study used data extracted from the Integrated Health Surveillance Platform (Mortality and Birth Monitoring Dashboard). The investigated variables included age, race/skin color, region of residence, and type of obstetric cause of death. After calculating the maternal mortality ratios (MMRs), trends were analyzed using control charts based on the expected probabilities of the normal distribution to establish Zone C (central), Zone B (warning), and Zone A (control), with observations focused on points outside the control limits. Results: From 2000 to 2019, the MMR remained within the Central Zone of the chart, ranging from 52.30 in 2000 to 55.31 in 2019, followed by a marked increase during the COVID-19 pandemic (71.97 in 2020; 113.18 in 2021) and a return to pre-pandemic levels in 2022 (54.82). Women aged ≥ 40 years had the highest MMR, although a downward trend was observed after 2009 (248.70 in 2009; 150.00 in 2019; 125.70 in 2022). Black women presented the highest MMR (mean: 208.04), as did the North and Northeast regions (means: 69.51 and 68.41, respectively). Direct obstetric causes accounted for the highest MMR throughout the study period. Conclusion: Except during the pandemic years, MMR remained stagnant over time. Older women experienced the highest MMR, and the impact of social inequalities was evident, with Black women and those living in the North and Northeast regions also presenting higher mortality rates. More effective public policies targeting vulnerable populations are needed to reduce maternal mortality.