Occupation and maternal mortality in Brazil

Feitosa-Assis, Ana Isabela; Santana, Vilma Sousa

doi:10.11606/s1518-8787.2020054001736

Brasil

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Original Article • Rev. Saúde Pública 54 • 2020 • https://doi.org/10.11606/s1518-8787.2020054001736 linkcopy

Occupation and maternal mortality in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE To estimate maternal mortality ratio according to occupation in Brazil.

METHODS This is a mortality study conducted with national data from the Mortality Information System (SIM) and the Live Birth Information System (SINASC) in 2015. Maternal mortality ratios were estimated according to the occupation recorded in death certificates, using the Brazilian Classification of Occupation (CBO), version 2002.

RESULTS A total of 1,738 maternal deaths records were found, corresponding to a maternal mortality ratio of 57.6/100,000 live births. It varied among occupational groups, with higher estimates among service and agricultural workers, particularly for domestic workers (123.2/100,000 live births), followed by general agricultural workers (88.3/100,000 live births). Manicurists and nursing technicians also presented high maternal mortality ratio. Maternal occupation was not reported in 17.0% of SIM registers and in 13.2% of SINASC data. Inconsistent records of occupation were found.“Housewife” prevailed in SIM (35.5%) and SINASC (39.1%).

CONCLUSIONS Maternal mortality ratio differs by occupation, suggesting a work contribution, which requires further research focusing occupational risk factors. Socioeconomic factors are closely related to occupation, and their combination with work exposures and the poor access to health services need to be also addressed.

Maternal Mortality; Maternal Exposure; Occupational Risks; Occupational Stress; Health Status Disparities

Sociodemographic characteristics	Maternal deaths		Mothers of live births

	N	%	N	%
Age group in years
10–14	13	0.7	26,700	0.9
15–19	222	12.8	520,864	17.2
20–34	1,068	61.5	2,081,723	69.0
35 and older	435	25.0	387,916	12.9
Years of schooling
None	39	2.4	16,683	0.6
1–3	183	11.3	84,278	2.8
4–7	430	26.5	561,506	18.8
8–11	648	40.0	1,755,605	58.8
12 or more	175	10.8	553,180	18.5
Ignored	145	9.0	16,620	0.5
Marital status
Single	783	47.5	1,246,029	41.6
Married	485	29.4	990,620	33.0
Consensual union	268	16.3	710,362	23.7
Others	53	3.2	37,880	1.3
Ignored	60	3.6	12,231	0.4
Race/skin color
White	559	33.3	1,062,962	37.1
Black	176	10.5	149,906	5.2
Brown	903	53.9	1,616,650	56.5
Others	38	2.3	33,044	1.2

Great groups (BCO 2002)	Maternal deaths		Mothers of live births		MMR (per 100,000 live births)	R MMR

	N	%	N	%
[2] Science and arts professionals^a	71	4.1	236,611	7.8	30.0	1.0 (referent)
[5] Service workersretail sellers from stores and supermarkets	209	12.0	287,787	9.5	72.6	2.4
[6] Agricultural, forestry and fishing workers	179	10.3	289,131	9.6	61.9	2.1
[4] Administrative service workers	89	5.1	206,175	6.8	43.2	1.4
[3] Mid-level technicians	58	3.3	117,282	3.9	49.5	1.7
[7-8] Workers of industrial goods and services production	37	2.1	71,927	2.4	51.4	1.7
[1] Senior members of the public authorities, leaders of public interest organizations and companies, managers	27	1.6	53,933	1.8	50.1	1.7
Housewifeb	618	35.6	1,180,364	39.1	52.4	1.7
Student^b	101	5.8	150,413	5.0	67.1	2.2
Others	22	1.3	18,083	0.6	-	-
Ignored	31	1.8	7,493	0.3	-	-
Missing	296	17.0	398,004	13.2	-	-
Total	1,738	100.0	3,017,203	100.0	57.6	-

Main subgroups and occupations (CBO 2002)	MMR (per 100,000 live births)	R MMR
[2] Science and arts professionals
[23] Social and human sciences professionalsa	26.2	1.0 (referent)
[25] Teaching professionals	45.1	1.7
[22] Biological sciences, health and related professionals	26.6	1.0
[5] Service workers, retail sellers from stores and supermarkets
[51] Service workers	79.4	3.0
[5121-05] Domestic worker	123.2	4.7
[5161-20] Manicurist	84.7	3.2
[52] Sellers and trade services providers	60.2	2.3
[5211-10] Retail Seller	53.5	2.0
[6] Agricultural, forestry and fishing workers
[62] Agricultural workers	68.0	2.6
[6210-05] General agricultural worker	88.3	3.4
[6220-20] Seasonal farm worker	59.0	2.3
[61] Producers in agricultural exploitation	40.0	1.5
[6120-05] Agricultural producer	45.1	1.7
[4] Administrative service workers
[41] Clerks	44.7	1.7
[4110-10] Administrative assistant	33.5	1.3
[42] Customer service workers	41.6	1.6
[4211-25] Cash Operator	38.0	1.5
[3] Mid-level technicians
[32] Mid-level technicians of biology, biochemistry, health and related sciences	67.8	2.6
[3222-05] Nursing technician	65.1	2.5
[35] Mid-level technicians in administrative sciences	42.7	1.6
[3547-05] Sales Representative	71.4	2.7
[7-8] Workers of industrial goods and services production
[76] Workers in the textile, tanning, clothing and graphic arts industries	54.4	2.1
[1] Senior members of the public authorities, leaders of public interest organizations and companies, managers
[14] Managers	56.3	2.1

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[TFN1] Note: Totals differ due to missing data.