Oswaldo Cruz Foundation, Brazil
Title: Temporal trends in maternal mortality rate in Brazil
Biography: Célia Landmann Szwarcwald
Introduction: This study proposes a methodology for estimating maternal mortality rates (MMR) in Brazil using vital data (deaths and live-births) reported to the Ministry of Health information systems. Methods: The proposed methodology considers three different correction factors: under-reporting of live births; under-reporting of deaths among women of child bearing age and misclassification of maternal deaths. Analysis of investigation of deaths among women of reproductive age provided the proportion of misclassification of maternal deaths. Using this method, the MMR was estimated in the period 2008-13. Previous estimates of the MMR in the 1990-2005 were used to obtain temporal trends. Results: In the period 2008-2013, the proportion of investigated deaths increased from 47% to 61% resulting in the reduction of misclassified maternal deaths. The MMR decreased from 66.9 to 57.4 per 100,000 live births. The highest MMR was evidenced in 2009 (73.1 per 100,000 live births) probably due to the H1N1 influenza epidemic that occurred in the same year. Considering previous MMR estimates in 1990, 1996 and 2005, the annual rate of decrease of the MMR was 3.7%. Due to the improvement in mortality reporting, the comparison of the MMR calculated with corrected and informed vital data showed more pronounced decreasing trends after correcting the data. Conclusions: Despite the downward trend during the period 1990 to 2013, the results of this study indicate that maternal mortality rates in Brazil are still unacceptably high and inconsistent with the great coverage of antenatal care and skilled birth attendance.