Maternal mortality in Pernambuco: spatial and temporal analysis before and during the COVID-19 pandemic

Oliveira, Henry Johnson Passos de; Bonfim, Cristine Vieira do; Barbosa, Celivane Cavalcanti; Maciel, Monicky Mel Silva Araújo; Silva, Amanda Priscila de Santana Cabral

doi:10.1590/1806-9304202520240158-en

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 25 • 2025 • https://doi.org/10.1590/1806-9304202520240158-en linkcopy

Maternal mortality in Pernambuco: spatial and temporal analysis before and during the COVID-19 pandemic

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives: to analyze the spatial distribution and temporal trend of the maternal mortality ratio in Pernambuco, before and during the COVID-19 pandemic.

Methods: mixed ecological study, based on the maternal mortality ratio. The spatial units were the resident municipalities and health regions in the pre-pandemic (2017-2019) and pandemic (2020-2022) periods. The risk ratio was calculated using the pre-pandemic period as a reference. The temporal units were semesters, analyzed using the Joinpoint regression model.

Results: the maternal mortality ratio increased by 14.5%, from 55.9 to 64.0 per 100,000 live births; an increase was observed in five health regions and in 63 (50.8%) of the 124 municipalities with registered deaths. In the time series, a decreasing trend in the ratio was observed between the first half of 2021 and the second half of 2022.

Conclusion: maternal mortality increased in some health regions and in most municipalities, highlighting the need to prioritize pregnant and postpartum women during health crises. The temporal analysis shows a decreasing trend, suggesting effective actions by health services. The implementation ofpolicies that ensure the continuity of care is crucial to reduce preventable maternal deaths.

Key words:
COVID-19; Maternal mortality; Time series studies; Spatial analysis; Ecological studies

Health region	Pre-pandemic			Pandemic
Health region	Maternal deaths	Live-births	MMR	Maternal deaths	Live-births	MMR	Risk ratio
I	90	173,583	51.8	104	151,432	68.7	1.32
II	18	23,397	76.9	15	22,129	67.8	0.88
III	15	25,098	59.8	16	21,823	73.3	1.23
IV	31	59,424	52.2	34	56,650	60.0	1.15
V	13	24,580	52.9	11	23,129	47.6	0.90
VI	10	18,598	53.8	6	17,950	33.4	0.62
VII	6	6,797	88.3	6	6,560	54.7	0.62
VIII	13	26,407	49.2	17	25,317	67.1	1.36
IX	11	17,383	63.3	10	16,697	59.9	0.95
X	4	8,012	49.9	5	7,523	66.5	1.33
XI	7	11,234	62.3	6	10,962	54.7	0.88
XII	10	13,024	76.8	8	11,915	67.1	0.87
PE	228	407,537	55.9	238	372,087	64.0	1.14

	Trend	Period		SPC	Confidence interval		p
	Trend	Initial	Final	SPC	Minimum	Maximum	p
SPC	1^st	2017.1	2019.2	−5.4	−15.7	6.0	0.246
	2^nd	2019.2	2021.1	18.9	−28.7	98.3	0.401
	3^rd	2021.1	2022.2*	−22.7*	−40.2	−2.8	0.049

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Instituto de Medicina Integral Prof. Fernando Figueira Rua dos Coelhos, 300. Boa Vista, 50070-550 Recife PE Brasil, Tel./Fax: +55 81 2122-4141 - Recife - PR - Brazil
E-mail: revista@imip.org.br

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[TFN1] Source: MS/SVS/CGIAE – Mortality Information System (SIM); Data collected on April 10, 2025; MMR= maternal mortality ratio.