Abstract
To describe the evolution of maternal mortality right after the establishment of maternal death committees in the region of the city of Ribeirão Preto, state of São Paulo, Brazil. The present study describes the spatial and temporal distribution of maternal mortality frequencies and rates, using data from the state of São Paulo, the municipality of Ribeirão Preto, and its Regional Health Department (DRS-XIII) from 1998 to 2017. The present ecological study considered the maternal mortality and live birth frequencies made available by the Computer Science Department of the Brazilian Unified Health System (Departamento de Informática do Sistema Único de Saúde, DATASUS, in the Portuguese acronym)/Ministry of Health, which were grouped by year and political-administrative division (the state of São Paulo, the DRS-XIII, and the city of Ribeirão Preto). The maternal mortality rate (MMR) was calculated and presented through descriptive measures, graphs, and cartograms. The overall MMR observed for the city of Ribeirão Preto was of 39.1; for the DRS-XIII, it was of of 40.4; and for the state of São Paulo, it was of 43.8 for every 100 thousand live birhts. During this period, the MMR for the city of Ribeirão Preto ranged from 0% to 80% of the total maternal mortalities, and from 40.7% to 47.2% of live births in the DRS-XIII. The city of Ribeirao Preto had an MMR of 76.5 in 1998and 1999, which decreased progressively to 12.1 until the years of 2012 and 2013, and increased to 54.3 for every 100 thousand live births over the past 4 years. The state of São Paulo State had an MMR of 54.0 in 1998-1999, which varied throughout the study period, with values of 48.0 in 2008-2009, and 54.1 for every 100 thousand live births in 2016-2017. Several times before 2015, the city of Ribeirão Preto and the DRS-XIII reached the Millennium Goals. Recently, however, the MMR increased, which can be explained by the improvement in the surveillance of maternal mortality. The present study describes a sharp decline in maternal death in the region of Ribeirão Preto by the end of 2012-2013, and a subsequent and distressing increase in recent years that needs to be fully faced.
Highlights
Maternal mortality is an important public health problem that must be addressed with effective and permanent measures, and its determinants are directly associated with the organization of the healthcare service and the increased value of women in society.[1]
The maternal mortality rates (MMRs) were obtained by taking the counts of deaths of pregnant women plus the counts of deaths of women that happened up to the 42nd day after delivery by causes related to pregnancy or not, with the exception of accidental deaths; theses sums were divided by the total live births according to temporal and spatial strata, and their results were expressed for every 100 thousand live births.[8,9]
Among the data reported for the DRS-XIII, in the period, 43.1% of maternal mortalities and 44.5% of live births occurred in Ribeirão Preto; the percentage of maternal mortality for this municipality ranged from 0% to 80.0%, and the percentage of live births, from 40.7% to 47.2%
Summary
Maternal mortality is an important public health problem that must be addressed with effective and permanent measures, and its determinants are directly associated with the organization of the healthcare service and the increased value of women in society.[1] Maternal mortality has long been the subject of international discussions and of the Brazilian health reform in the mid-1980s, highlighting the efforts of Anibal Faúndes, a Chilean working in Brazil who helped create the Comprehensive Women’s Health Care Program (Programa de Assistência Integral à Saúde da Mulher, PAISM, in the Portuguese acronym). The program broke the traditional view that women’s care should be centered on reproductive issues, which contributed to the creation of the Maternal Mortality Committees.[2] The Maternal Mortality Prevention Program of the Department of Health of the State of São Paulo, which was created in 1987, was a precursor of the Maternal Mortality Committees, established in 1988 with the creation of the Botucatu, Campinas, Marília, Ribeirão Preto, and São Paulo committees. The committees were located in the medical schools of those regions, and, based on their initial experience, the program was later disseminated throughout Brazil.[3,4,5] A progressive structuring of committees throughout the country occurred, institutionalizing the program at the national, state, regional, municipal and local levels.[6]
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