Banca de DEFESA: JULIO CESAR PONTES

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : JULIO CESAR PONTES
DATE: 21/10/2025
TIME: 14:00
LOCAL: Videoconferência via Gerência de Redes do CCET/UFRN
TITLE:

MATERNAL MORTALITY IN BRAZIL BEFORE AND DURING THE COVID-19 PANDEMIC: AN ANALYSIS OF TERRITORIAL AND RACIAL INEQUITIES

KEY WORDS:

Maternal Mortality; Obstetric Racism; COVID-19; Health Inequities; Reproductive Behavior

PAGES: 200
BIG AREA: Ciências Sociais Aplicadas
AREA: Demografia
SUBÁREA: Política Pública e População
SUMMARY:

Maternal mortality constitutes a violation of women’s sexual and reproductive rights. In Brazil, the Maternal Mortality Ratio (MMR) remains high and unevenly distributed, reflecting racial and territorial inequities sustained by structural determinants and institutional racism. The COVID-19 pandemic worsened this scenario by restricting timely access and degrading the quality of care across the pregnancy–postpartum continuum, thereby increasing risk and preventable deaths. We aimed to analyze the temporal association between the pandemic and MMR in Brazil, by Federative Unit (UF) and by race/color (white and Black women).We conducted an ecological time-trend study. Maternal deaths were obtained from the Ministry of Health Monitoring Panel (corrected records), and live births from SINASC/DataSUS microdata. In the descriptive analysis, annual MMR was estimated by UF, race/color, and cause (direct/indirect), reporting separately the MMR for pretas (Black), pardas (brown/mixed-race), and for negras (pretas + pardas; combined Black) to avoid masking racial inequities. Monthly MMR medians between the prepandemic period (Jan/2017–Mar/2020) and the pandemic period (Mar/2020–Dec/2022) were compared using the Mann–Whitney U test. For ITS analyses, we fitted negative binomial regression models including seasonality and accounting for residual autocorrelation; we estimated β₁ (pre-intervention trend), β₂ (level change at Mar/2020), and β₃ (post-intervention slope change), and reported relative risk (RR = exp[β]), 95% confidence intervals (95% CI), and p-values (α = 0.05).During the pandemic, maternal deaths increased by 28.5% (from 4,949 to 6,357), peaking in 2021. MMR rose in most UFs, more intensely and persistently among Black women, especially in the North and Northeast. In several states, the increase among pretas was roughly double that observed among white women; pardas also showed substantial increases. Both direct and indirect causes rose during the pandemic, with a pronounced surge in indirect causes among Black women. ITS results indicated a predominantly stationary pre-intervention trend. For total MMR, a significant level increase at the onset of the pandemic (RR_{β₂} > 1; p < 0.05) was observed in 15 UFs, with higher RRs in the North and Northeast, and a downward slope change during the pandemic (β₃ < 0; p < 0.05) only in Alagoas, Goiás, and São Paulo. Among Black women, there was an abrupt increase in 11 UFs—concentrated in the North and Northeast—without subsequent reversal (non-significant β₃). Among white women, a level change was identified in Ceará, Alagoas, Maranhão, and São Paulo, with a decreasing trend in São Paulo and Paraíba. The pandemic was associated with a widening of racial and territorial inequities in maternal mortality. These findings underscore the need for resilient obstetric-care policies grounded in racial and territorial equity, ensuring continuous, high-quality access to antenatal, intrapartum, and postpartum care.

COMMITTEE MEMBERS:
Externa à Instituição - ANGELITA ALVES DE CARVALHO - ENCE
Externo à Instituição - COSME MARCELO FURTADO PASSOS DA SILVA - Fiocruz - RJ
Externa à Instituição - GRACIMARY ALVES TEIXEIRA - UFPB
Presidente - 1855608 - KARINA CARDOSO MEIRA
Interna - 2081758 - LUCIANA CONCEICAO DE LIMA
Interno - 1688188 - MOISES ALBERTO CALLE AGUIRRE