Even with a public policy focused on maternal and child health for more than a decade, Brazil has not managed to reduce racial and regional inequalities associated with maternal deaths, which have been exacerbated by the Covid-19 pandemic.
One of the main obstetric complications that lead to maternal death is arterial hypertension (preeclampsia and eclampsia). In 2014, the ratio was 25.2 per thousand births. In 2021, it rose to 33.3 (34% more). “The best solution to reduce these deaths is an investment in primary care, efficient prenatal care,” says Agatha Eleone.
The fulfillment of the goals of the six prenatal consultations is linked to part of the financing of primary care, within the Previne Brazil Program, but 35% of Brazilian municipalities did not reach that goal in 2022, according to data from Impulso Gov.
Boa Vista, in Roraima, was one of them. In the first two years of the pandemic, the city also had the highest fatality rate of pregnant and postpartum women hospitalized for Covid (47.7%) among Brazilian capitals, according to an analysis by OOBr (Observatório Obstetrico Brasileiro). Palmas, in Tocantins, appears in second place, with 31%, and Rio Branco, in Acre, has 29.4%. The average for the country as a whole was 9.4%.
“These pregnant women went through the emergency room and arrived directly at the ICU in a very critical condition. Were we prepared? No, we were not. The maternity hospital does not have an ICU and there were moments [en el HGR, Hospital Geral de Roraima] When we looked at the patients, seeing the overcrowding, we said: “Where should I put the next one?” recalls Helinana Barros Machado Machado, an intensive care nurse at HGR. According to Gabrielle Almeida Rodrigues, technical manager at Boa Vista for women’s health, the high mortality rate in 2021 was related to Covid: of the 28 deaths registered in the capital, 21 were due to complications derived from the infection.
“We only have one public maternity hospital in the State and we do not have a maternal ICU. Today it works precariously, in an improvised place. In addition to not being a suitable place, it has a great deficit of professionals. This is the main obstacle.” Roraima has 15 municipalities, but only Boa Vista has a maternity hospital and a single high-complexity public hospital. All serious cases in the interior are sent to the capital, and are added to those of pregnant Venezuelans and indigenous people. The State led maternal deaths in the country in 2021, with 282 deaths per 100,000 live births, a level similar to that of African countries.
“Demand has grown a lot with immigration. We increase the number of professionals, of exams, but it is never enough,” says Rodrigues. According to the manager, the municipality has created new basic health units, expanding the existing ones, in addition to hiring and investing in professional qualification. In the 31st week of pregnancy, Genny, a 22-year-old Venezuelan, an indigenous Warao, had her first prenatal visit last month, at a UBS in Boa Vista. It is her third pregnancy and the first in which she is monitored, thanks to an alliance between UBS and UNFPA (United Nations Population Fund). “I liked her,” she summed up as she left the office where she heard the baby’s heartbeat.
In a statement, the Roraima Health Secretariat said that the State has been registering a large increase in the demand for maternal and child care and that the main challenge of the Nossa Senhora de Nazareth Maternal-Infant Hospital has been to guarantee assistance to Venezuelan women . , who arrive at the unit without prenatal control and with a high-risk clinical picture. In 2022, 7,272 general visits were made to Venezuelans, with 2,329 deliveries.
In total, the maternity unit performs around 50,000 deliveries a year. The secretariat also says that the works on the maternity hospital are almost finished and that there are projects to build a unit in the western part of Boa Vista, the most populated part of the capital, in addition to the expansion of the Délio de Oliveira Tupinambá Hospital, in Pacaraima, on the border with Venezuela. Secretary Nésio Fernandes, secretary of primary care at the Ministry of Health, says that the goal of reducing maternal deaths by 2030 is achievable as long as investments in the maternal-infant network are made in a short period of time.
“All the diagnoses have already been made. Now it depends on a portfolio of decisions that bring investments to the health regions. According to Fernandes, the conditions that lead to maternal deaths go far beyond the actions that can be carried out in the primary care “They require a hospital structure, with capillarity of obstetric beds, obstetric and neonatal ICUs throughout the country. ” Fernandes says that, in this first semester, the federal administration is developing a cycle of strategic and intersectoral planning, for the allocation of financial resources But since this will happen in practice, changes in Rede Cegonha and the amounts involved will only be announced in the second half, according to the secretary.
Maternal Mortality Feature Series is produced in conjunction with the Pulitzer Center
Translated by AZAHARA MARTIN ORTEGA
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