Maternal mortality in Brazil (2020-2024): macro-regional distribution, direct and indirect causes and the role of Rede Cegonha and PNAISM

Abstract

Introduction: Maternal mortality is a sensitive indicator of health quality and social inequalities. It involves direct, often preventable, and indirect, often underreported causes. In low- and middle-income countries, such as Brazil, the problem persists as a structural and public health challenge, requiring continued attention. Objective: To analyze the distribution and evolution of maternal mortality from direct and indirect causes in Brazil's macroregions (2020-2024) and to discuss the areas of action of the RC and PNAISM. Methods: Quantitative research of secondary data. Data were obtained from the Maternal Mortality Monitoring Panel. Deaths from direct and indirect causes, aged 10 to 49 years, were selected. Statistical analyses were performed in Microsoft Excel® and scripts via Google Colab®, using one-way ANOVA, Tukey's test (HSD), and Poisson regression. Results: The analysis of maternal mortality due to direct causes revealed significant differences between regions (F = 93.96; p < 0.001). The Northeast and Southeast had higher mean rates than the Central-West, North, and South (p < 0.0001). Poisson regression indicated temporal stability (β = -0.0003) and a three-fold higher risk in the Northeast (3.30) and Southeast (3.13) compared to the Central-West. For indirect causes, ANOVA did not detect significant regional differences (F = 1.79; p = 0.17), but the regression showed higher relative rates in the Southeast (3.55) and Northeast (2.59), in addition to a 30% annual reduction in indirect mortality (relative rate = 0.70). Conclusion: Maternal mortality in Brazil reveals significant regional disparities, especially in direct causes, highlighting the urgency of public policies aimed at ensuring safe and equitable maternal care.