An unpublished study led by Fiocruz Amazônia evaluated the excess maternal deaths in Brazil during the first 15 months of the COVID-19 pandemic. Epidemiologist Jesem Orellana, of the Leônidas and Maria Deane Institute (ILMD/Fiocruz Amazônia), together with researchers from Brazilian, Colombian and North-American universities, showed the very worrying increase in maternal deaths in Brazil, especially during the trimester from March to May 2021, the most critical phase of the second wave of the COVID-19 pandemic, in all age groups and in all regions of the country.
During the five consecutive trimesters evaluated in the study, from March 2020 to May 2021, 3,291 maternal deaths were identified in Brazil, resulting in 70% excess deaths or 1,353 maternal deaths beyond the expected numbers. The North Region, one of the most vulnerable in the country, was the only one in which an excess of maternal deaths in the 37-49 years age group was observed in the five trimesters under study. In addition, in the South Region an explosive situation was observed in maternal deaths in the March to May 2021 trimester, especially among women from 37 to 49 years old, with a markedly high increase of 375% in excessive maternal mortality.
The study was based on official mortality data from the Brazilian Ministry of Health and on a contrafactual analysis methodology (it counterposes what was observed in the pandemic and what was to be expected without the pandemic). “We know that the direct impact of the pandemic on mortality by COVID-19 resulted in more than 687,000 known deaths in Brazil, placing the country in a definite second place worldwide in the number of deaths by the disease. In Brazil, misinformation regarding the use of clinically ineffective drugs to prevent or treat COVID-19, and even the rejection of scientific evidence for the use of masks, social distancing and even the efficacy and safety of vaccines made it very difficult to implement public health measures to mitigate the effects of the pandemic”, explains Orellana, who coordinates the Laboratory of Modeling in Statistics, Geoprocessing and Epidemiology (Legepi) of Fiocruz Amazônia.
In the paper titled Excess maternal mortality in Brazil: Regional inequalities and trajectories during the COVID-19 epidemic, the authors explain this relation and show results not yet explored in the country. The authors concluded that there has been a marked excess maternal mortality rate in Brazil and that its trajectories during the period of time under study were regionally heterogeneous, with consistently more substantial impacts during the most acute periods of the pandemic. This reflects not only socioeconomic inequalities and heterogenous access to health services prior to the pandemic, but also a worsening of these issues, especially in the North and North East Regions. The paper has been accepted for publication on Plos One.
“The high rate of maternal deaths observed in Brazil reflects fully preventable deaths, given the deterioration of suitable access to health services and of the quality of the services provided to pregnant and puerperal women, and it also suggests a worsening of social and regional inequalities. The study also suggests that the delay in the inclusion of pregnant and puerperal women among the priority groups for vaccination, in mid-May 2021, the subsequent and mistaken suspension of vaccination for women of these groups who had no morbidities, as well as the slow vaccination against COVID-19 in the remaining population during explosive dissemination of the Gamma variant, may have contributed for the exceptionally high number of preventable maternal deaths in Brazil, highlighting the urgent need to perfect maternal-infant health policies during a sanitary crisis”, ponders the epidemiologist.
Finally, the researcher considers that the general pattern of excess maternal deaths reinforces the dramatic development of the epidemic in Brazil. This compromises Brazil’s efforts in previous years to achieve the Sustainable Development Goals (SDGs), which aimed to further reduce maternal mortality and ensure universal access to high-quality services and reproductive health for women by 2030.