Context of maternal mortality among indigenous Brazilian women of reproductive age: ecological study

Authors

DOI:

https://doi.org/10.59464/2359-4632.2025.3695

Keywords:

Intersectionality, Women's Health, Indigenous Population Health, Maternal Mortality, Health Information Systems

Abstract

Objective: To analyze the patterns and contextual determinants of maternal mortality among indigenous women in Brazil from 2020 to 2024. Method: This is an ecological study using data from the Brazilian Obstetric Observatory. The analysis was conducted in a descriptive manner where measures of central tendency were calculated, carried out in the R software. Results: It was observed that brown and black women represent the highest proportions, corresponding to 53% and 12%, respectively. The proportion of indigenous women is significant in the North (58%). Direct deaths predominated, accounting for 52% of cases, while indirect deaths accounted for 45%. The immediate puerperium was the period with the highest concentration of deaths (61%), although 84% of women received care, there were few autopsies (9.7%) and death investigations (22%). Conclusion: The study highlights the urgency of interventions to reduce racial inequalities. By prioritizing cultural and social specificities, public policies can guarantee equitable access to health and prevent avoidable deaths.

Keywords: Intersectionality; Women's Health; Indigenous Population Health; Maternal Mortality; Health Information Systems

References

Fundação Oswaldo Cruz – FIOCRUZ. Estudo aponta 70% de excesso de mortes maternas no Brasil na pandemia. Out 2022. https://portal.fiocruz.br/noticia/estudo-aponta-70-de-excesso-de-mortes-maternas-no-brasil-na-pandemia

Kozhimannil KB, Interrante JD, Tofte AN, Admon LK. Severe Maternal Morbidity and Mortality Among Indigenous Women in the United States. Obstet Gynecol. Feb, 2020;135(2):294-300. https://doi.org/10.1097/AOG.0000000000003647

Granados Y, Gastelum Strozzi A, Alvarez-Nemegyei J. Alnequity and vulnerability in Latin American Indigenous and non-Indigenous populations with rheumatic diseases: a syndemic approach. BMJ Open 2023;13:e069246. https://doi.org/10.1136/bmjopen-2022-069246

Armenta-Paulino N, Wehrmeister FC, Arroyave L, Barros AJD, Victora CG. Ethnic inequalities in health intervention coverage among Mexican women at the individual and municipality levels. EClinicalMedicine. Dec 2021, 3;43:101228. https://doi.org/10.1016/j.eclinm.2021.101228

Garnelo L, Horta BL, Escobar AL, Santos RV, Cardoso AM, Welch JR, et al. Avaliação da atenção pré-natal ofertada às mulheres indígenas no Brasil: achados do Primeiro Inquérito Nacional de Saúde e Nutrição dos Povos Indígenas. Cadernos De Saúde Pública, 2019;35, e00181318. https://doi.org/10.1590/0102-311X00181318

Marmot M. The Health Gap: The Challenge of an Unequal World: the argument. Int J Epidemiol. Aug, 2017. 1;46(4):1312-1318. https://doi.org/10.1093/ije/dyx163

Souza STH, Castro ACG, Fernandes FECV, Pereira RCLF, Santos JMA, Melo RA. Vivência de Racismo Institucional por Mulheres Negras em Serviços de Saúde. Revista Psicologia E Saúde, 2024;16(2), e16282568. https://doi.org/10.20435/pssa.v16i1.2568

Werneck J. Racismo institucional e saúde da população negra. Saúde E Sociedade, 2016;25(3), 535–549. https://doi.org/10.1590/S0104-129020162610

Souza JP, Day LT, Rezende-Gomes AC, Zhang J, Mori R, Baguiya A, et al. A global analysis of the determinants of maternal health and transitions in maternal mortality. Lancet Glob Health. Feb, 2024;12(2):e306-e316. https://doi.org/10.1016/S2214-109X(23)00468-0

Anderson I, Robson B, Connolly M, Al-Yaman F, Bjertness E, King A, Yap L, et al. Indigenous and tribal peoples' health (The Lancet–Lowitja Institute Global Collaboration): A population study. The Lancet, 2019;388(10040), 131-157. https://doi.org/10.1016/S0140-6736(16)00345-7

Petersen EE, Davis NL, Goodman D, Cox S, Syverson C, Seed et al. Racial/Ethnic Disparities in Pregnancy-Related Deaths - United States, 2007-2016. MMWR Morb Mortal Wkly Rep. Sep, 2019. 6;68(35):762-765. https://doi.org/10.15585/mmwr.mm6835a3

Truth and Reconciliation Commission of Canada. Honoring the truth, reconciling for the future: Summary of the final report of the Truth and Reconciliation Commission of Canada. Ottawa: Truth and Reconciliation Commission. 2015. https://irsi.ubc.ca/sites/default/files/inline-files/Executive_Summary_English_Web.pdf

Australian Institute of Health and Welfare (AIHW). Maternal deaths in Australia 2018-2020. Canberra: AIHW. 2021. https://www.aihw.gov.au/reports/mothers-babies/maternal-deaths-in-australia-2018-2020/summary

Pan American Health Organization (PAHO). Report on Indigenous Women’s Maternal Health in Latin America and the Caribbean. Washington, DC: PAHO. 2023. https://iris.paho.org/handle/10665.2/57403

Gabrysch S, Lema C, Bedriñana E, Bautista MA, Malca R, Campbell OM, Miranda JJ. Cultural adaptation of birthing services in rural Ayacucho, Peru. Bull World Health Organ. Sep, 2009;87(9):724-9. https://doi.org/10.2471/blt.08.057794

Enríquez CY. Desigualdades en la cobertura y en la calidad de la atención prenatal en Perú, 2009-2019. Rev Panam Salud Publica, 2022;46:e47. https://doi.org/10.26633/RPSP.2022.47

Stephens C, Porter J, Nettleton C, Willis R. Disappearing, displaced, and undervalued: A call to action for Indigenous health worldwide. The Lancet, 2006;374(9683), 65-75. https://doi.org/10.1016/S0140-6736(06)68892-2

Brasil. Ministério do Desenvolvimento e Assistência Social, Família e Combate à Fome (MDS). Transformando nosso mundo: A Agenda 2030 para o Desenvolvimento Sustentável. 2016. https://www.mds.gov.br/webarquivos/publicacao/Brasil_Amigo_Pesso_Idosa/Agenda2030.pdf

Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke, JP, STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. Oct, 2007. 20;335(7624):806-8. https://doi.org/10.1136/bmj.39335.541782

Francisco R, Lacerda L, Rodrigues AS. Obstetric Observatory BRAZIL – COVID-19: 1031 maternal deaths because of COVID-19 and the unequal access to health care services. Clinics (Sao Paulo, Brazil), 2021;76, e3120. https://doi.org/10.6061/clinics/2021/e3120

Brasil. Ministério da Saúde. Conselho Nacional de Saúde. Resolução nº 466, de 12 de dezembro de 2012. https://www.gov.br/conselho-nacional-de-saude/pt-br/acesso-a-informacao/legislacao/resolucoes/2012/resolucao-no-466.pdf/view

Cardoso LM, Souza MMCF, Guimarães RUC. Morte materna: uma expressão da "questão social". Serviço Social & Sociedade, 2010;(102), 244–268. https://doi.org/10.1590/S0101-66282010000200004

Moliterno ACM, Borghi AC, Orlandi LHSF, Faustino RC, Serafim D, Carreira L. Processo de gestar e parir entre as mulheres Kaingang. Texto & Contexto - Enfermagem. 2013;22(2), 293–301. https://doi.org/10.1590/S0104-07072013000200004

Barbosa VFB, Caponi SNC. Direitos humanos, vulnerabilidade e vulneração dos povos indígenas brasileiros no enfrentamento à Covid-19. Physis: Revista De Saúde Coletiva, 2022;32(2), e320203. https://doi.org/10.1590/S0103-73312022320203

Lopes GJ, Dantas-Silva A, Garanhani SF, Guida JP. Maternal deaths among Brazilian indigenous women—Analysis from 2015 to 2021. International Journal of Gynecology and Obstetrics, 2024 Nov;167(2):612-618. https://doi.org/10.1002/ijgo.15607

McLeod M, Gurney J, Harris R, Cormack D, King P. COVID-19: we must not forget about Indigenous health and equity. Aust N Z J Public Health. Aug, 2020;44(4):253-256. https://doi.org/10.1111/1753-6405.13015

Lopes Garrafa J, Dantas-Silva A, Garanhani Surita F, de Siqueira Guida JP, Bhadra Vale D, de Campos Brandão M, Trapani A Junior, Knobel R. Maternal deaths among Brazilian indigenous women Analysis from 2015 to 2021. Int J Gynecol Obstet. 2024;167: 612-618. https://doi.org/10.1002/ijgo.15607

Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, Gülmezoglu AM, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014 Jun;2(6):e323-33. https://doi.org/10.1016/S2214-109X(14)70227-X

GBD 2015 Maternal Mortality Collaborators. Global, regional, and national levels of maternal mortality, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016 Oct 8;388(10053):1775-1812. https://doi.org/10.1016/S0140-6736(16)31470-2

Paulino NA, Vázquez MS, Bolúmar F. Indigenous language and inequitable maternal health care, Guatemala, México, Peru and the Plurinational State of Bolivia. Bull World Health Organ. 2019 Jan 1;97(1):59-67. https://doi.org/10.2471/BLT.18.216184

Souza EV. Atenção ao pré-natal em uma Unidade Básica de Saúde Fluvial de Manaus. 2018. 103f. Dissertação [Mestrado em Saúde Pública] - Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, 2018.

Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, et al. Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet. 2010 May 8;375(9726):1609-23. https://doi.org/10.1016/S0140-6736(10)60518-1

Filippi V, Chou D, Ronsmans C, Graham W, Say L. Levels and Causes of Maternal Mortality and Morbidity. The World Bank; 2016 Apr 5. https://www.dcp-3.org/sites/default/files/chapters/DCP3%20RMNCH%20Ch3.pdf

Geller SE, Koch AR, Garland CE, MacDonald EJ, Storey F, Lawton B. A global view of severe maternal morbidity: moving beyond maternal mortality. Reprod Health. 2018 Jun 22;15(Suppl 1):98. https://doi.org/10.1186/s12978-018-0527-2

Downloads

Published

2025-07-31

How to Cite

Gonçalves dos Santos, G. G. dos ., Lima Cordeiro da Silva, A. L. C. da, Silva do Nascimento, E. S. do ., Costa, T., María Bermejo Gil, B. M. B. ., López Pedraza, L. L., & Aparecida Gonçalves Vidotti, G. A. G. . (2025). Context of maternal mortality among indigenous Brazilian women of reproductive age: ecological study. Revista Científica Integrada, 8(1), e202518. https://doi.org/10.59464/2359-4632.2025.3695

Issue

Vol. 8 No. 1 (2025): Revista Científica Integrada

Section

Original article

License

Copyright (c) 2025 Revista Científica Integrada

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Most read articles by the same author(s)