Maternal mortality: a new estimate for Pernambuco, Brazil
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This dissertation examines maternal mortality measurement in Pernambuco, Brazil, as well as the correlates and patterns of maternal mortality in this Northeastern State. In 2003, fieldwork was carried out in five meso-regions of Pernambuco using the RAMOS method, and based on death certificates of women of reproductive ages registered in the local System of Information on Mortality. In-depth interviews of family members were also conducted for the abortion-related deaths. Of the 1,258 female deaths investigated, 54 maternal deaths were identified, corresponding to a Maternal Mortality Ratio of 77 per 100,000 live births. The estimated level of underreporting was 46%, corresponding to an upward adjustment factor 1.9. The leading cause of death was pregnancy-induced hypertension (a direct cause of maternal death), followed by diseases of the circulatory and respiratory system (indirect causes of maternal death). The illegal condition of abortion in Brazil was the most important contributing factor for the abortion-related deaths. Approximately 94% of the overall maternal deaths were judged to be avoidable based on improvements in the quality of health care. After a decade in this area (1994 to 2003), maternal mortality declined by 11%, but there was no improvement in the level of underreporting of maternal deaths. Suggestions for the improvement of health care among women and for the reporting of maternal mortality are provided.