Peer-reviewed article
Influence of sociodemographic and obstetric factors on maternal mortality in Brazil from 2011 to 2021.
Eric Renato Lima Figueiredo, Claudia do Socorro Carvalho Miranda, Ana Cristina Viana Campos, Fabiana de Campos Gomes, Cibele Nazaré Câmara Rodrigues et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This peer-reviewed study analyzes maternal mortality in Brazil from 2011 to 2021, examining how sociodemographic factors and obstetric indicators relate to deaths from direct and indirect causes. The research found that mortality patterns varied by region, marital status, race, prenatal care access, and delivery method. Regional differences were significant, with the northern region showing different mortality patterns. Women with fewer antenatal visits and those without education had higher mortality risks.
Key points
- Mortality during pregnancy increased over the study period while mortality during puerperium decreased
- Fewer than 4 antenatal visits was a strong predictor of increased maternal mortality across multiple demographic groups
- Northern and northeastern regions had higher indirect maternal mortality rates
- Cesarean delivery was associated with increased mortality risk in certain demographic groups
- White women and those in stable unions showed lower indirect cause mortality
Limitations
This is an ecological study based on aggregate data and mortality statistics rather than individual-level data, which limits causal inference. The study does not evaluate an intervention but rather describes associations between sociodemographic factors and observed mortality outcomes.
Abstract
BACKGROUND: Obstetric causes are classified as direct (complications of pregnancy, childbirth or the puerperium) or indirect (caused by pregnancy but not directly caused by it). This study aimed to analyze maternal mortality from obstetric causes in Brazil from 2011 to 2021. METHODS: This was an ecological study on mortality and live births. The outcomes were the specific risk of mortality from direct and indirect cause adjustment and death during pregnancy and the puerperium. Binary and multiple linear logistic regressions were used to assess the influence of sociodemographic factors and maternal and child health indicators on maternal mortality and time of death (pregnancy and puerperium). RESULTS: Regarding mortality during pregnancy and during the puerperium, increased (p = 0.003) and decreased (p = 0.004) mortality over the years, respectively; residing in the northern region was associated with lower (p < 0.05) and greater (p = 0.035) odds; and the Maternal Mortality Committee was the primary and least active source of investigation, respectively (p < 0.0001). The number of deaths from indirect causes increased with age (p < 0.001) and in the northern region (p = 0.011) and decreased in the white (< 0.05) and stable union (0.002) regions. Specifically, for mortality risk, the age group [women aged 15-19 years presented an increase in cesarean section (p < 0.001) was greater than that of women who had < 4 antenatal visits (p < 0.001)], education [women who completed high school (8 to 11 years) was greater when they had < 4 prenatal visits (p = 0.018)], and marital status [unmarried women had more than 4 antenatal visits (p < 0.001); cesarean birth (p = 0.010) and < 4 antenatal visits (p = 0.009) were predictors of marriage; and women in a stable union who had < 4 prenatal visits and live births to teenage mothers (p < 0.001) were predictors]. Women who had no education (p = 0.003), were divorced (p = 0.036), had cesarean deliveries (p < 0.012), or lived in the north or northeast (p < 0.008) had higher indirect specific mortality risk. CONCLUSIONS: Sociodemographic factors and maternal and child health indicators were related to different patterns of obstetric mortality. Obstetric mortality varied by region, marital status, race, delivery, prenatal care, and cause of death.