The following excerpt was translated from Portuguese. To read the original story in full, click here.
Stories help explain why Brazil doubled its maternal mortality rate during the pandemic.
BELÉM, Pará, Brazil—Áurea Monteiro, 28, died at 3:45 pm on March 31, 2021, in the ICU of Santa Casa de Belém, in Pará. Five hours later, Dienne Santos, 38, died in a UPA (Emergency Care Unit) seven kilometers away.
Both had complications from Covid after childbirth, leaving their babies orphaned and a trail of grief that lingers in the families.
In the capital of the neighboring state, Boa Vista, Roraima, indigenous health nurse Gracione da Silva Santos, 44, still mourns the death of his wife Almiza Prado, 37, in June 2020, in the first year of the pandemic. Today he cares for his youngest child, Valentina, who was born with her mother intubated in the ICU, as well as four other children.
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The stories expose flaws in public and private healthcare services at the height of the health crisis. They help to explain why Brazil doubled its maternal mortality rate in 2021, with the North region in the lead, and point out the priority areas that require improvement to prevent what are avoidable deaths in 90% of situations.
Data from the federal government program Previne Brasil, extracted by Impulso Gov, a non-profit organization, show that, on average, 34% of Brazilian municipalities were unable to carry out six prenatal consultations for 45% of their pregnant women (target of the program) in 2022. In the North region, this rate almost doubled.
Housewife Dienne Santos was one of the pregnant women who did not undergo prenatal care during the pandemic for fear of Covid, according to her mother-in-law Antonia Eremita Santos, from Belém. She started experiencing symptoms of the infection seven days after giving birth to Giovanni on March 14, 2021.
Suffering from severe coughing, she looked for a UPA (Emergency Care Unit), and there she was medicated and released. That same night, with a fever and shortness of breath, she returned to the health unit. With no beds available in the ICU, she was admitted and then intubated. She died in the UPA after ten days, leaving her husband, baby, and 6 and 9-year-old daughters.
According to the OOBr (Brazilian Obstetric Observatory), puerperal women hospitalized by Covid were 2.5% more likely to die from complications of the infection compared to pregnant women.
"In the puerperium [period up to 42 days after childbirth], women have a greater risk for thrombosis, and Covid also predisposes to thrombosis. The cesarean section already leads to an inflammatory response and it can be enhanced by Covid", explains the obstetrician Rossana Pulcineli Francisco, professor at USP and coordinator of OOBr.
According to Milena Ferreira Porfírio, coordinator of the Health Department of Belém, the increase in maternal mortality was related to the fact that maternal and child actions were put on hold, with efforts being mostly directed towards fighting Covid.
At the state level, the Department of Health in Pará attributes the increase in maternal deaths during the pandemic to the lack of structure in primary care. He says that the state has reorganized and strengthened the work process at maternal and childcare levels, from the prenatal program to high-complexity hospitals.
Roraima, where Almiza died, led the ranking of maternal mortality in 2021, with 281.7 deaths per 100,000 live births, a level similar to that of African countries.
The State Health Department claims that it has registered a substantial increase in the demand for assistance in all available units.
According to the cabinet, a series of measures have been adopted to improve the care process, such as training professionals, hiring civil servants, and evaluating indicators.
Bottlenecks of obstetric care in the North
Translated by Cassy Dias.