Covid-19: maternal mortality more than doubles in 2021 and returns to 1980s levels

Three years ago, Brazil experienced the most critical moment of the Covid-19 pandemic, with an increase in contagion and deaths in all Brazilian regions. An unprecedented survey by the Oswaldo Cruz Foundation (Fiocruz) shows that the maternal mortality rate more than doubled in 2021 compared to the trend in previous years. According to data published on Monday (29) in the “Revista Brasileira de Saúde Materno Infantil”, this excess caused this indicator to reach a level similar to the rate in the 1980s, of 110 maternal deaths per 100,000 live births.

The analysis highlights an excess of deaths among pregnant and postpartum women, even considering an expected increase in deaths due to the pandemic. This indicator followed a trend of 39% increase in general mortality during the period.

Pregnant and postpartum women, however, died more than non-pregnant women – there were 3 thousand deaths in 2021. The data shows that, in 2021, there was an excess of maternal deaths of more than 51.8% in relation to women’s deaths non-pregnant women, comparing the trend of recent years.

The impact of the health emergency worsened, mainly, in the second year of the pandemic. According to the data, 60% of maternal deaths in 2021 were due to Covid-19, while in 2020 it was only 19%. Excess maternal mortality in 2021 was greater than 57% compared to 2020 and 83.7% compared to general mortality in these years.

The work analyzed the growth in the number of deaths of pregnant and postpartum women in 2020 and 2021, comparing with data on maternal mortality from previous years and mortality of non-pregnant women, of childbearing age, from 15 to 49 years old, in the same period. For this, data from the Mortality Information System (SIM) of maternal deaths between 2015 and 2021 and data from the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) were used.

The 2021 maternal mortality rate exceeds the target of 70 maternal deaths per 100,000 live births set by the UN Sustainable Development Goals. The indicator was already above the target before the pandemic, with emphasis on some states and municipalities in a more critical situation. “After the pandemic, maternal mortality doubled in magnitude, placing the entire country back in this same critical zone”, explains Raphael Guimarães, researcher at Fiocruz and co-author of the study.

Maternal mortality is related to the quality of medical care during prenatal care. Thus, countries with less infrastructure and access to health services tend to have higher rates of this type of death. According to the researchers, the scenario of hospital overload during the pandemic may have contributed to the increase in these deaths, in addition to the precarious public health structure in several regions of the country.

“Maternal health is one of the outcomes most severely affected by the pandemic”, concludes Guimarães. For him, it is now necessary to investigate the long-term effects of the pandemic on the organization of the health system, brought to light by the increase in maternal mortality. “It is possible that the debate about health inequities will become increasingly evident in the coming years”, he concludes.