After a Record High in the Covid Pandemic, Maternal Deaths from Preventable Causes Occur Again in Brazil
Three years after the start of the Covid-19 pandemic, a period in which maternal mortality rates in Brazil doubled, going back to levels recorded 25 years ago, pregnant and puerperal women are now more protected against Sars-CoV-2. However, they have started dying again from causes such as hypertension, hemorrhages, and infections, considered preventable in 90% of situations. The country already has many weak points in obstetric care, but, with the health crisis, these weaknesses have intensified. One of the most important indicators is the maternal mortality ratio (RMM), which computes deaths related to complications during pregnancy and up to 42 days after the birth of the child (puerperium). In 2021, the RMM pointed out that, for every 100,000 live births, there were 110 deaths of women, the same rate recorded in 1998. Preliminary data from the Ministry of Health, compiled by the OOBr (Brazilian Obstetric Observatory), show that the number is almost twice as much as in 2019, the period before the pandemic when the ratio was 57.9 deaths. In 2020, the official rate was 71.9 deaths per 100,000 live births. In absolute numbers, there were 1,964 deaths in 2020 and 2,941 deaths in 2021. Data for 2022 have not yet been consolidated. Just for the sake of comparisons, in the United States, there were 861 maternal deaths in 2020 and 1,178 in 2021, according to the CDC (Center for Disease Control and Prevention). Together, they represent less than half of Brazilian deaths during this period. Brazil is a signatory to the agreement settled with the UN in 2015 to reduce, by 2030, the maternal mortality ratio to a maximum of 30 per 100,000 live births, that is, almost a quarter of the number registered in 2021. The 2019 report from the Ministry of Health obtained by Folha shows that there is a 95% chance that the country will not reach this target. The Maternal Mortality Ratio projected by the ministry's technicians for 2030 is 55.6 deaths per 100,000 live births. Folha news team has toured cities in the north of the country, a region with a mortality rate of 140.8 deaths per 100,000, the highest in the country, and heard from health professionals, managers, and, mainly, families who lost pregnant women and found a series of problems in the network of maternal and child care. Roraima led the ranking of maternal mortality in 2021, with 281.7 deaths per 100,000 live births, a level similar to that of countries in sub-Saharan Africa, such as Mozambique. In developed countries, the rate is around 10 per 100,000. The deaths of Thais Kauana Rodrigues Diniz, 21, and her baby, in Boa Vista (RR), exemplify some of the obstacles. The young woman lived in a mining region, and was in her 19th week of pregnancy, but had not had any prenatal consultations. She arrived at the Nossa Senhora de Nazareth maternity ward on January 12 with abdominal pain and loss of amniotic fluid. The maternity ward works in an improvised structure inside the tents of a field hospital. The original building has been under renovation since June 2021 On the tenth day of Thais hospitalization, it was discovered that the fetus had died inside the womb, according to her aunt, Alessandra Araujo. The baby's death adds to another 27 registered at the maternity hospital from the beginning of this year until February 7. In 2022, there were 20 deaths. "She spent two days suffering after receiving medication to induce labor. She didn't want to eat anymore, her belly started to swell up, and she just moaned in pain. I asked for help, and it was clear that she was getting worse, but they said that the swelling was an accumulation of gases. The situation in there is chaotic", says Alessandra. Already in serious condition, Thais was taken to the General Hospital of Roraima, the only SUS with an ICU in the capital. Tests revealed uterine rupture and generalized infection (septicemia). She underwent surgery, was intubated, and died two days later, on January 27. The maternity ward denies any negligence in the care of the patient. Regarding the deaths of babies, the state government says that the causes are diverse, "with part of them being related to the lack of adequate prenatal care". About the maternity ward, he says that the building renovation services are in the final stage. The series of reporting articles on Maternal Mortality is a partnership with the Pulitzer Center.