Brazil had 4,000 more deaths of pregnant and postpartum women than recorded in 6 years, says study

The deaths of pregnant women and postpartum women in six years in Brazil are 3,922 more than recorded by the Ministry of Health, points out a survey by the Brazilian Obstetric Observatory (OOBR) released this Thursday (7). This number represents an increase of about 34% in mortality associated with pregnancy.

The work collected information from 2016 to 2021. According to official data from the SIM (Mortality Information System), 11,436 deaths of pregnant or postpartum women were reported within 42 days of delivery.

The new data will be available from this Thursday in an organization’s database. “The goal of OOBR is to take databases that are already available and turn that into dashboards. [mais fácil acesso]”, says Rossana Vieira Francisco, associate professor of obstetrics at the Faculty of Medicine of the University of São Paulo and coordinator of the OOBR.

Officially, a maternal death occurs during pregnancy or up to 42 days after the baby is born. It is also necessary that the cause of death -examples are hypertension, diabetes and infections, such as Covid-19- is related to the pregnancy or has been aggravated by it.

But there are still late maternal deaths, when they occur between 43 days and up to a year of delivery and also need to have some cause that is related to the pregnancy.

“For example, a woman who got pregnant and got Covid. The delivery was done and she was admitted to the ICU. She died 43 days after delivery. She is considered a late maternal death”, says Francisco.

The observatory study took these two categories into account and reviewed data from the Ministry of Health’s SIM (Mortality Information System).

The first step was to observe the number of maternal deaths that the ministry considers from 2016 to 2021 of females aged between 10 and 49 years.

Death certificates were then analyzed, which have a field for the cause of death.

Some diseases are considered causes of maternal deaths. An example is diabetes. If the doctor includes the category “diabetes mellitus in pregnancy” on the certificate for a woman who dies during pregnancy or within 42 days after delivery, the death is classified as maternal death.

The doctor also fills in the field death of a woman of childbearing age. In it, it is pointed out whether death occurred in pregnant women, during childbirth, when having an abortion, after childbirth or if it did not occur in these periods.

The researchers investigated death certificates with a positive response for the scenarios of death of pregnant or postpartum women of up to 42 days. In addition, they analyzed in the field of cause of death a response that is not considered as maternal death, but could be related to pregnancy. From there, cases of deaths of pregnant and postpartum women that are not reported were found.

Diabetes, again, is an example. Some certificates indicated that the woman died while pregnant or within 42 days of delivery, but the cause of death included the generic “diabetes mellitus” category. In this case, according to the authors of the study, the ideal would be to add the answer “diabetes mellitus in pregnancy”.

In the case of diabetes, the analysis noted that the number of maternal deaths caused by the disease rose from 16 — the official SIM number — to 20 after the review proposed by the survey.

Using this method, the researchers found maternal deaths that had not been recorded as such – not only in the case of diabetes, but also for other diseases. Between 2016 and 2021, for example, 1,232 were observed in this scenario.

“This number represents about 12% more [de mortes maternas até 42 dias]”, says Vieira Francisco.

The survey also investigated disregarded data on late maternal deaths. The method was the same, but only considered deaths in which the doctor recorded in the certificate that occurred after 43 days. In this case, there were 2,690 unaccounted for deaths from 2016 to 2021.

Agatha Rodrigues, professor in the statistics department at the Federal University of Espírito Santo (Ufes) and coordinator of the research data analysis, says that the difference between deaths in these two periods of puerperium is still an open question.

“There’s been a lot of discussion as to whether we should consider [a morte no puerpério depois de 42 dias] as maternal death”, says the teacher. “What makes a 42-day postpartum woman different from a 43-day-old woman? Why is one considered as maternal death and another not? “, she asks, referring to the criterion of the Ministry of Health.

external causes

The study also analyzed the deaths of pregnant and postpartum women caused by external events. In this case, the deaths are not categorized as maternal deaths – not even late – because they do not have a direct or associated relationship with pregnancy. Examples are deaths that occur by suicide or firing a firearm.

The problem, say the researchers, is that the information is not provided by the Ministry of Health. For example, the database does not allow you to see how many pregnant women were run over by a car.

This lack of filters increases the problem of underreporting in the country. The survey observed that for every 100 deaths of pregnant women, of puerperal women up to one year after childbirth and of women who have abortions in Brazil, 28 are not reported – including deaths from external causes.

“These deaths are not considered maternal deaths. But since we are talking about pregnant and postpartum women, it is important to have these statistics even to study and analyze over time”, concludes Rodrigues.