In 2021, Brazil had an average of 107 deaths per 100,000 births, according to the Maternal Mortality Monitoring Panel.
The maternal mortality rate refers to the number of women who die during pregnancy or within 42 days of childbirth due to or aggravated pregnancy-related causes per 100,000 live births in a given year in a country. Death is caused by any factor related to or aggravated by pregnancy or measures taken in connection with this period.
At the International Day to Fight for Women’s Health and National Day for the Reduction of Maternal Mortality celebrated this Saturday (28), the vice-president of the National Commission Specialized in Maternal Mortality of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo), Rodolfo de Carvalho Pacagnella, says that maternal deaths can be avoided.
Brazil presents numbers far from those established by the United Nations (UN). Until 2015, the goal was to achieve less than 35 deaths per 100,000 births and Brazil was in the range of 70 to 75 maternal deaths per 100,000 live births . With the Sustainable Development Goals (SDGs), the UN has indicated, by 2030, to reduce the global maternal mortality rate to less than 70 deaths per 100,000 live births.
According to Pacagnella, the numbers have not dropped significantly in Brazil since 2014. On the other hand, high-income countries, in general, have a maternal mortality ratio that varies between 10 and 20 deaths per 100,000 births. Most of these occurrences are of indirect causes, which are not preventable during pregnancy.
According to Pacagnella, most maternal deaths could be avoided. The big question, she said, is not the number of maternal deaths, but why they happen and the consequences they bring.
“The big question is that she [morte] usually happens due to preventable causes. These are situations that could have been identified during the care of this pregnant woman, during prenatal care and, especially, in the moments close to birth. And those conditions were not identified and not addressed in a timely manner.”
And this delay in recognizing the serious situation and in treating this condition leads, as a result, to maternal death, he said.
According to the vice-president of the Febrasgo Commission, the consequence of maternal mortality is disastrous, because women have always been, but today have a recognized role, as a central individual in the social, emotional and financial organization of the family. The death of a woman during childbirth or the puerperium leads to a disruption of everything that involves her, pointed out the doctor.
“Frequently, there is a disorganization of the family, disorganization of the care of the children, perpetuation of poverty, a series of issues that come due to the fact that she is a fundamental figure in the organization of that community, not only of the family, but of the community as a whole”.
In Brazil, the main cause of maternal death is hypertension. In second place, hemorrhage appears, followed by unsafe abortion and puerperal infection. Then come the indirect causes, associated with existing physical conditions, or worsened during pregnancy, such as heart disease, kidney disease, cancer, among others.
The main causes are preventable, reiterated Rodoldo Pacagnella. Today, we know how to make the diagnosis and how to identify a woman who is at risk of developing hypertension in pregnancy, called preeclampsia, and how to treat this condition, preventing the woman from dying.
The same occurs in relation to hemorrhage and, also, to conditions related to sepsis, which is a generalized infection. This issue gained relevance during the pandemic of the new coronavirus, according to the specialist, because there was an increase in maternal deaths from respiratory diseases, as a consequence of a little attentive look at the pregnant woman, who is a population at risk for the severity of these diseases, especially the viral ones associated with the coronavirus.
Preliminary data indicate that the number of maternal deaths from SARS-CoV-2 has increased from 1,500, which had been recorded in the last 6 years, to 2,200 in 2021. “And this excess mortality was mainly due to the conditions associated with severe acute respiratory syndrome”.
Overcrowding in hospitals also led to an increase in maternal mortality from other causes, as care capacity was exhausted. “And maternal mortality is very focused on the period close to childbirth, when women need hospital care to recognize these conditions”, said the expert.
The doctor pointed out that maternal death happens because there is no objective view of women’s health needs. The fact that the woman has a condition with a higher risk of dying from pregnancy is a biological factor. But the death of these women because of these other factors is a social issue, he warned.
“It concerns how we look at these needs and pay attention to them. It is not an intrinsic biological condition, but the lack of adequate access to health services at a time when women need it most”.
The reduction of maternal mortality depends, first of all, on the need for a social understanding of the importance of women in the context of the country’s social formation, said Pacagnella.
“As a central figure in the constitution of society, women should have greater respect. This means having public policies that ensure access and quality assistance to maternal and child health services. This involves easy access to quality health policies, primary care, even emergency services,” she argued.
According to Pacagnella, these points have already begun to be addressed in some policies, albeit in a peripheral way. To actually reduce maternal mortality, Brazil has to build a care network that is capable of recognizing serious situations, with trained professionals and specialists in gynecology and obstetrics, said the expert.
“We need a structured and very organized health network”, he recommended. “The training of professionals is an important part of this process, but the establishment of a care system is fundamental, with priority definition by the Unified Health System (SUS)”.
Febrasgo is involved in a series of training actions for professionals on the importance of women in the constitution of society and, also, in actions for the implementation of clinical and management improvement processes, for the treatment of issues associated with seriousness, in partnership with other institutions, until there is a creation of a national perception on the importance of this topic.
Febrasgo considers the 28th as a reference point to talk about the importance of looking at the condition of women in society.
“Especially at this moment when we realize that there is an excess of mortality, due to a disease that could have been managed in another way and whose death could have been avoided if there had been a more attentive action, with a good targeting of actions for the woman’s needs at the time of delivery,” said Pacagnella.
Rodolfo Pacagnella warns that society needs to look at the condition of women. “We are doing little. The deaths that occurred in recent years were due to the lack of an adequate organization for the management of the risk that women face in these conditions. It is important for us to show this and fight for it not to happen again”, he concluded.
Source: CNN Brasil