The National Day for the Reduction of Maternal Mortality and the International Day for the Struggle for Women's Health is celebrated every May 28th. In 2022, Brazil has nothing to celebrate. The number of maternal deaths has increased over the last five years by 47,93% in the country, and increased between 2020 and 2021, one of the consequences of the Covid-19 pandemic. The same trend was followed in Rio Grande do Norte. The numbers, extracted by the Santos Dumont Institute (ISD) from the Ministry of Health's Maternal Mortality Monitoring Panel, show a negative increase of 40,12% in notifications of deaths of pregnant women, during childbirth or postpartum throughout the state. 

In the national scenario, in absolute numbers, the number of deaths among Women of Childbearing Age (WF), between 10 and 49 years old, jumped from 62,650 in 2017 to 92,682 in 2021. Among the main causes of death in this sample of the population are: hemorrhage, hypertension and puerperal infection, which can occur up to 42 days after delivery. COVID-19 alone was responsible for the death of approximately 1,500 pregnant women, according to a survey by the University of São Paulo (USP). In Rio Grande do Norte, in the same five-year period, deaths in this sample of the population jumped from 942 to 1,320. At least 55 of them died after being infected with the coronavirus in the state. 

“Prenatal care, assistance during childbirth and the postpartum period are extremely important for a peaceful pregnancy and postpartum period. It is during these moments that we, as members of a healthcare team, can identify problems and prevent complications that could lead to death. When a woman dies during pregnancy or postpartum, at the height of her adulthood and full reproductive capacity, there is a rupture, an impact on the family structure and, mainly, on the upbringing of surviving children,” highlights Thaíse Lopes, obstetrician-gynecologist preceptor at ISD. 

Studies around the world published by the United Nations (UN) indicate that between 401 and 501 percent of maternal deaths are preventable. Maternal mortality is considered an important indicator for measuring the quality of health services, whether public or private, offered to the population. Proper care for pregnant women and prompt identification of complications that may pose a risk to the maintenance of the pregnancy and the survival of the baby and the mother herself are key factors. Delayed care, however, is a risk that may contribute to the rise in negative statistics related to maternal and infant mortality in Brazil and worldwide. 

One of the women who did not survive the complications caused by the novel coronavirus during pregnancy was housewife Maria Aparecida Camilo de Souza, 39. After being admitted to the Emergency Care Unit (UPA) in Macaíba twice with respiratory symptoms characteristic of COVID-19 and not being hospitalized, she was treated by infectious disease specialist Carolina Damásio, a preceptor and researcher at the Santos Dumont Institute (ISD). Upon noticing that the disease was worsening, the doctor referred Maria Aparecida to the Giselda Trigueiro Hospital in Natal. She was admitted to an Intensive Care Unit (ICU) bed, but died a few days later. Maria Aparecida was six months pregnant and underwent an emergency C-section. The baby was born alive, but did not survive. She leaves behind a daughter who will turn 15 in 2022.

Preceptor Thaíse Lopes highlights that the increase in deaths among pregnant women throughout 2020 and 2021 was due to Covid-19. “This disease was unknown, with unknown clinical management and with a high potential for complications in pregnant and postpartum women. On the other hand, many health services closed or dedicated themselves exclusively to treating patients with Covid-19. These two aspects had a negative impact and contributed to the increase in deaths in this population.” 

Structural problems

The rise in maternal mortality data in Brazil highlights another problem: the lack of infrastructure in healthcare facilities. “In addition to the problems inherent to the pregnancy-puerperal cycle, healthcare services are not well structured. There are insufficient beds, poor materials, and clinical staff that cannot meet the growing demand due to working conditions,” says Thaíse Lopes. 

According to data from the Ministry of Health, Rio Grande do Norte has 6,196 beds distributed across units linked to the Unified Health System (SUS). Of these, 401 are for surgical obstetrics and 597 for clinical obstetrics. 

Dates

The International Day of Struggle for Women's Health was defined at the 4th International Meeting on Women and Health, held in 1984 in the Netherlands, when maternal death became increasingly important. From that date on, the topic gained greater interest and at the 5th International Meeting on Women and Health, held in San José, Costa Rica, in 1987, the Latin American and Caribbean Women's Health Network (RSMLAC) proposed that, each year, on May 28, a theme would help guide political actions aimed at preventing preventable maternal deaths.

The main objective of these commemorative dates is to draw attention and raise awareness in society about various health problems common in women's lives, such as: breast cancer, endometriosis, urinary tract infection, cervical cancer, fibromyalgia, depression and obesity.

The main objective of prenatal and postpartum care is to ensure maternal and fetal well-being. To this end, primary care teams must care for women from the beginning of pregnancy (as early as possible, at the beginning or even before pregnancy); recognize, monitor and treat the main causes of maternal and fetal morbidity and mortality; and be available when complications occur during pregnancy and the postpartum period.

Numbers

See below the evolution of maternal mortality in RN from 2017 to 2021. 

Parameter: Woman of Childbearing Age (WFA)

Year 2017

Brazil: 62,650

Rio Grande do Norte: 942

Year 2018

Brazil: 62,035

Rio Grande do Norte: 974

Year 2019

Brazil: 62,683

Rio Grande do Norte: 968

Year 2020

Brazil: 71,879

Rio Grande do Norte: 1,070

Year 2021*

Brazil: 92,682

Rio Grande do Norte: 1,320

*Years shown with * are preliminary

Source: Maternal Mortality Monitoring Panel – Department of Health Analysis and Surveillance of Non-Communicable Diseases (DASNT) – Ministry of Health