Evolução da mortalidade materna no Brasil: uma análise comparativa de séries temporais

Abstract

Maternal mortality (MM) in Brazil requires multiple strategies for addressing it. This indicator is highly sensitive to the quality of healthcare services and the economic and social conditions. Its incidence is calculated from the Maternal Mortality Ratio (MMR), which includes the number of maternal deaths and live births. The records are consolidated through death certificates in the Mortality Information System (SIM), providing data for health managers and professionals to make informed decisions. In this context, the present study aims to analyze national MM data from 1996 to 2022, dividing the time frame into two phases: before and during the COVID-19 pandemic. This is a qualitative and quantitative, ecological, observational, retrospective, descriptive, cross-sectional, and analytical study that examines MM data by region. Data collection was conducted using the DataSUS platforms, covering information related to the indicator, with a focus on the profile and incidence of cases. The analyses were based on a triangulation of methods: document research, time series analysis, and integrative review. The data analysis used the RStudio program, allowing the modeling of trends and generating forecasts. The statistical tests applied were the KPSS test for stationarity and the Kruskal-Wallis test for seasonality, aiming to understand the characteristics of the series. The significance level adopted for hypothesis testing was 5%. The integrative review included four selection stages, resulting in 17 articles for analysis. The results showed that although Brazil had made progress in reducing maternal mortality rates over the past decades through the implementation of coping strategies, the impact of the COVID-19 pandemic caused a significant setback, exacerbating regional inequalities and increasing maternal deaths, especially in more vulnerable areas. The analysis of data from 1996 to 2022 indicated a clear variation in MM rates between regions, with a notable increase in deaths in the North and Northeast regions, related to deficiencies in healthcare infrastructure and access to quality services. The study also showed that factors such as the lack of professional training, resource scarcity, and healthcare system overload during the pandemic contributed to the worsening of risk conditions such as hemorrhages and obstetric complications. Furthermore, it was identified that the implementation of regionalized decision models, focusing on local specificities, could potentially reduce MM by improving healthcare system responses to the needs of pregnant individuals in different contexts. In conclusion, MM continues to be an important public health indicator, reflecting social, economic, and healthcare access inequalities in different regions of Brazil. Despite advancements in obstetric care over the past decades, the COVID-19 pandemic exposed and exacerbated weaknesses in the healthcare system, resulting in a significant increase in MM, especially in more vulnerable regions. By analyzing the variables associated with maternal deaths and the responses of health policies, it is expected to provide information for addressing this issue and thus contribute to reducing disparities in access to care and improving maternal outcomes in the country.