Racial disparities and maternal mortality in Brazil: findings from a national database

Silva, Amanda Dantas; Guida, José Paulo Siqueira; Santos, Debora de Souza; Santiago, Silvia Maria; Surita, Fernanda Garanhani

doi:10.11606/s1518-8787.2024058005862

Brasil

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Review • Rev. Saúde Pública 58 • 2024 • https://doi.org/10.11606/s1518-8787.2024058005862 linkcopy

Racial disparities and maternal mortality in Brazil: findings from a national database

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE To assess maternal mortality (MM) in Brazilian Black, Pardo, and White women.

METHODS We evaluated the maternal mortality rate (MMR) using data from the Brazilian Ministry of Health public databases from 2017 to 2022. We compared MMR among Black, Pardo, and White women according to the region of the country, age, and cause. For statistical analysis, the Q² test prevalence ratio (PR) and confidence interval (CI) were calculated.

RESULTS From 2017 to 2022, the general MMR was 68.0/100,000 live births (LB). The MMR was almost twice as high among Black women compared to White (125.81 vs 64.15, PR = 1.96, 95%CI:1.84–2.08) and Pardo women (125.8 vs 64.0, PR = 1.96, 95%CI: 1.85–2.09). MMR was higher among Black women in all geographical regions, and the Southeast region reached the highest difference among Black and White women (115.5 versus 60.8, PR = 2.48, 95%CI: 2.03–3.03). During the covid-19 pandemic, MMR increased in all groups of women (Black 144.1, Pardo 74.8 and White 80.5/100.000 LB), and the differences between Black and White (PR = 1.79, 95%CI: 1.64–1.95) and Black and Pardo (PR = 1.92, 95%CI: 1.77–2.09) remained. MMR was significantly higher among Black women than among White or Pardo women in all age ranges and for all causes.

CONCLUSION Black women presented higher MMR in all years, in all geographic regions, age groups, and causes. In Brazil, Black skin color is a key MM determinant. Reducing MM requires reducing racial disparities.

Health Disparities; Racism; Women’s Health Services

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Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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Skin color	Black	White	Pardo	Black versus White		Black versus Pardo
Skin color	MMR	MMR	MMR	PR (95%IC)	p-value	PR (95%IC)	p-value
Total	125.8	64.1	64.0	1.96 (1.84–2.08)	< 0.001	1.96 (1.85–2.09)	< 0.001
Year
2017	117.7	54.9	56.1	2.14 (1.81–2.53)	< 0.001	2.10 (1.79–2.45)	< 0.001
2018	104.0	49.9	55.5	2.08 (1.75–2.47)	< 0.001	1.87 (1.59–2.20)	< 0.001
2019	104.4	49.2	53.6	2.12 (1.79–2.51)	< 0.001	1.95 (1.66–2.28)	< 0.001
2020	127.6	64.8	68.8	1.97 (1.69–2.29)	< 0.001	1.85 (1.61–2.14)	< 0.001
2021	190.8	118.6	96.8	1.61 (1.42–1.82)	< 0.001	1.97 (1.75–2.21)	< 0.001
2022	97.5	47.1	49.3	2.08 (1.67–2.58)	< 0.001	1.98 (1.61–2.42)	< 0.001
Period
Pre-pandemic (2017–2019)	108.4	51.4	55.1	2.11 (1.91–2.32)	< 0.001	1.97 (1.79–2.16)	< 0.001
COVID-19 Pandemic (2020–2021)	144.1	80.5	74.8	1.79 (1.64–1.95)	< 0.001	1.92 (1.77–2.09)	< 0.001

Variables	Black	White	Pardo	Black versus White		Black versus Pardo
Variables	MMR	MMR	MMR	PR (95%IC)	p-value	PR (95%IC)	p-value
Age
0–19	82.8	49.0	42.4	1.69 (1.35–2.11)	< 0.001	1.95 (1.60–2.39)	< 0.001
20–29	97.1	50.3	48.3	1.93 (1.74–2.15)	< 0.001	2.01 (1.82–2.22)	< 0.001
30–39	167.5	74.9	93.3	2.24 (2.03–2.46)	< 0.001	1.79 (1.63–1.97)	< 0.001
40 or more	301.0	141.3	178.3	2.13 (1.71–2.65)	< 0.001	1.69 (1.37–2.08)	< 0.001
Region
North	186.0	182.2	75.9	1.02 (0.79–1.31)	0.924	2.45 (1.96–3.06)	< 0.001
Northeast	141.8	106.6	66.1	1.33 (1.16–1.52)	< 0.001	2.14 (1.92–2.40)	< 0.001
South	108.0	43.6	56.7	1.90 (1.73–2.08)	< 0.001	2.07 (1.89–2.28)	< 0.001
Southeast	115.5	60.8	55.7	2.48 (2.03–3.03)	< 0.001	1.90 (1.51–2.41)	< 0.001
Midwest	132.7	83.9	65.7	1.58 (1.24–2.00)	< 0.001	2.02 (1.61–2.53)	< 0.001
Cause
Indirect	51.2	28.9	25.1	1.77 (1.60–1.96)	< 0.001	2.04 (1.85–2.25)	< 0.001
Direct (all)	70.8	32.9	36.9	2.15 (1.97–2.35)	< 0.001	1.92 (1.77–2.08)	< 0.001
Hypertension	25.6	8.97	10.9	2.85 (2.45–3.32)	< 0.001	2.35 (2.05–2.70)	< 0.001
Postpartum hemorrhage	10.1	6.70	7.10	1.52 (1.21–1.89)	< 0.001	1.43 (1.16–1.76)	< 0.001
Miscarriage	3.14	1.80	1.90	1.75 (1.17–6.22)	0.009	1.65 (1.12–2.42)	0.013
Infection	5.48	2.02	2.95	2.71 (1.95–3.75)	< 0.001	1.86 (1.38–2.49)	< 0.001