Estimation of maternal mortality rates in Brazil,
					2008-2011

Szwarcwald, Celia Landmann; Escalante, Juan José Cortez; Rabello Neto, Dácio de Lyra; Souza Junior, Paulo Roberto Borges de; Victora, César Gomes

doi:10.1590/0102-311X00125313

person Celia Landmann Szwarcwald

schoolInstituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.

person Juan José Cortez Escalante

schoolSecretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brasil.

person Dácio de Lyra Rabello Neto

schoolSecretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brasil.

person Paulo Roberto Borges de Souza Junior

schoolInstituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.

person César Gomes Victora

schoolFaculdade de Medicina, Universidade Federal de Pelotas, Rio Grande do Sul, Brasil.

Correspondence C. L. Szwarcwald Departamento de Informações em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4365, sala 225, Biblioteca de Manguinhos, Rio de Janeiro, RJ 21040-360, Brasil. celials@icict.fiocruz.br

Contributors

C. L. Szwarcwald was responsible for study design, participated in data analysis and interpretation and drafted this article and in the final approval of the version to be published. J. J. C. Escalante contributed to data collection and drafting this article and to final approval of the version to be published. D. L. Rabello Neto contributed to data collection and participated in data interpretation and in the drafting and final approval of the version to be published. P. R. B. Souza Junior contributed to data analysis and interpretation, drafting this article and to the final approval of the version to be published. C. G. Victora made a substantial contribution to study conception and design and contributed to the critical revision of relevant intellectual content of this manuscript, and also participated in drafting the text and in the final approval of the version to be published.

States and Region	Uninvestigated	Investigated	Total number of deaths among WRA	Proportion (%)	% municipalities * with investigation rate < 30%
RO	712	910	1,622	56.1	25.0
AC	306	449	755	59.5	33.3
AM	1,598	1,621	3,219	50.4	60.0
RR	128	311	439	70.8	0.0
PA	4,174	2,933	7,107	41.3	47.3
AP	537	16	553	2.9	100.0
TO	464	968	1,432	67.6	0.0
Total North Region	7,919	7,208	15,127	47.6	42.9
MA	3,990	1,981	5,971	33.2	69.0
PI	590	2,336	2,926	79.8	0.0
CE	1,125	6,403	7,528	85.1	0.0
RN	1,122	1,575	2,697	58.4	23.1
PB	1,835	1,869	3,704	50.5	20.0
PE	2,973	6,822	9,795	69.6	5.0
AL	2,412	1,166	3,578	32.6	54.5
SE	415	1,736	2,151	80.7	0.0
BA	9,162	5,917	15,079	39.2	46.9
Total Northeast Region	23,624	29,805	53,429	55.8	29.1
MG	7,444	13,851	21,295	65.0	14.2
ES	1,419	2,655	4,074	65.2	0.0
RJ	6,860	14,017	20,877	67,1	19.3
SP	21,879	19,905	41,784	47,6	19.4
Total Southeast Region	37,602	50,428	88,030	57,3	16.6
PR	2,744	8,516	11,260	75.6	0.0
SC	2,966	3,158	6,124	51.6	25.6
RS	6,515	4,929	11,444	43.1	50.7
Total South Region	12,225	16,603	28,828	57.6	25.7
MS	734	2,018	2,752	73.3	0.0
MT	537	2,758	3,295	83.7	0.0
GO	4,922	1,746	6,668	26.2	65.9
DF	1,049	1,441	2,490	57.9	0.0
Total Central Region	7,242	7,963	15,205	52.4	34.6
Brazil	88,612	112,007	200,619	55.8	25.6

Period in which death occurred/original underlying cause before the investigation	Reclassified as maternal deaths after investigation		Total investigated deaths among women of reproductive age	Proportion (%) of deaths reclassified as maternal
	No	Yes	Total investigated deaths among women of reproductive age	Proportion (%) of deaths reclassified as maternal
Outside pregnancy, childbirth and postpartum period
Not presumed	74,744	23	74,767	0.03
Presumed	20,199	20	20,219	0.10
Maternal death	48	72	120	60.00
Late maternal death	5	0	5	0.00
During pregnancy, childbirth and 43 days to one year postpartum or undefined
Not presumed	2,033	539	2,572	20.96
Presumed	739	482	1,221	39.48
Maternal death	80	2,224	2,304	96.53
Late maternal death	55	7	62	11.29
Ignored
Not presumed	7,930	7	7,937	0.09
Presumed	2,758	14	2,772	0.51
Maternal death	1	27	28	96.43
Late maternal death	-	-	-	-
Total	108,592	3,415	112,007	3.05

Period in which death occurred/ type of cause	Uninvestigated deaths among women of reproductive age	Proportion (%) of deaths that would have been reclassified as maternal	Deaths among women of reproductive age who would have been reclassified as maternal	Expected number of maternal deaths
Outside pregnancy, childbirth and postpartum period
Not presumed	12,718	0.03	3.8
Presumed	2,889	0.10	2.9
Maternal death	21	60.00	12.6	19
Late maternal death	2	0.00	0.0
During pregnancy, childbirth and 43 days to one year postpartum or undefined
Not presumed	536	20.96	112.3
Presumed	194	39.48	76.6
Maternal death	526	96.53	507.7	698
Late maternal death	11	11.29	1.2
Ignored
Not presumed	8,559	0.09	7.7
Presumed	2,849	0.51	14.5
Maternal death	75	96.43	72.3	95
Late maternal death	1	0.00	0.0
Total
Not presumed	21,813
Presumed	5,932
Maternal death	622			812
Late maternal death	14

Year	MMR (per 100 thousand live births)
1990 *	143.2
1996 *	103.2
2005	78.2
2008	66.9
2009	73.1
2010	67.5
2011	60.8
Annual rate of decline (%)	3.72 **

States and region	MMR (per 100 thousand live births)
RO	71.3
AC	41.4
AM	93.9
RR	64.6
PA	74.3
AP	59.5
TO	96.1
Total North Region	77.8
MA	114.0
PI	101.8
CE	73.4
RN	61.4
PB	56.6
PE	63.3
AL	55.1
SE	90.1
BA	87.9
Total Northeast Region	80.8
MG	55.5
ES	72.3
RJ	85.7
SP	52.3
Total Southeast Region	60.4
PR	63.3
SC	36.9
RS	55.7
Total South Region	54.5
MS	76.4
MT	76.7
GO	61.0
DF	48.7
Total Central Region	65.0
Brazil	68.2

[tfn01t01_en] AC: Acre; AL: Alagoas; AM: Amazonas; AP: Amapá; BA: Bahia; CE: Ceará; DF: Distrito Federal; ES: Espírito Santo; GO: Goiás; MA: Maranhão; MG: Minas Gerais; MS: Mato Grosso do Sul; MT: Mato Grosso; PA: Pará; PB: Paraíba, PE: Pernambuco; PI: Piauí; PR: Paraná; RJ: Rio de Janeiro; RN: Rio Grande do Norte; RO: Rondônia; RR: Roraima; RS: Rio Grande do Sul; SC: Santa Catarina; SE: Sergipe; SP: São Paulo, TO: Tocantins.

* Municipalities with an average of 10 or more deaths among women of reproductive age (WRA) in the 2009-2011 triennium.

Estimation of maternal mortality rates in Brazil, 2008-2011

Abstracts