Temporal Trend and Projections of the Maternal Mortality Ratio in Brazil and Geographic Regions, 1996–2023
Maternal Mortality. Time Series. Health Indicator. Women’s Health. Public Health.
Introduction: Maternal mortality remains a serious public health issue, particularly in developing countries, reflecting social and regional inequalities as well as shortcomings in health system organization. In this context, analyzing the evolution of maternal mortality in the country is an important initiative to support the development of strategies aimed at reducing this burden. Objective: To evaluate the temporal trend of the Maternal Mortality Ratio in Brazil and its geographic regions from 1996 to 2023, and to estimate projections for the years 2027 and 2030. Methods: This is a time-series study using secondary data from the Mortality Information System (SIM) and the Live Birth Information System (SINASC). The Maternal Mortality Ratio (MMR) was calculated based on the number of maternal deaths and live births, expressed as the number of maternal deaths per 100,000 live births. Trend and projection analyses were conducted using the Box–Jenkins methodology, which guides the construction of Autoregressive Integrated Moving Average (ARIMA) and Seasonal Autoregressive Integrated Moving Average (SARIMA) models according to the characteristics of each time series. Data stationarity was assessed using the Augmented Dickey–Fuller (ADF) test. Based on the coefficients estimated from the historical time series, projections of the Maternal Mortality Ratio were generated for 2027 and 2030. Analyses were performed in RStudio (version 2024.12.0 Build 467; © 2009–2024 Posit Software, PBC), adopting a 5% significance level (p < 0.05) for all statistical tests. Preliminary Results: Initial evaluation of the data indicated stability in Brazil’s Maternal Mortality Ratio over the study period, with a marked increase in 2020 and 2021 associated with the impact of the COVID-19 pandemic. National projections suggest the persistence of elevated maternal mortality levels, distancing the country from the national target established for 2030. Regional analysis showed an increasing trend in the Midwest, Northeast, and North regions, stability in the Southeast, and a decreasing trend in the South. Conclusion: Maternal mortality in Brazil exhibits heterogeneous patterns, reinforcing the need for public policies sensitive to territorial specificities, strengthened women’s health care, and continuous monitoring of this indicator.