Maternal Deaths in Brazil Are Reflection of The Pandemic Denial in the Bolsonaro Administration, Says Researcher

In 2021, the disease was responsible for 52% of deaths among pregnant and postpartum women in Brazil

While the classic causes of maternal death continue relentlessly in Brazil, the country is still investigating deaths from Covid in 2021, the year in which the disease alone was responsible for 52% of deaths of pregnant and puerperal women (1,524 out of a total of 2941).

A recent review of studies published in the journal BMJ Global Health shows that pregnant women with Covid have eight times more risk of death compared to uninfected pregnant women. Newborns also have a greater chance of complications in cases where the mother contracted Sars-CoV-2. An analysis published in The Lancet Regional Health Americas, in 2022, identified at least three barriers that Brazilian pregnant and postpartum women faced during the pandemic.

The first was the difficulty in accessing diagnostic tests. The second was to find vacancies in hospitals. There was an average delay of seven days between the onset of symptoms and hospitalization. Family members heard in the analysis report that the pregnant women went several times to the same hospital or to up to five different institutions before being admitted. The third barrier was access to adequate intensive care after hospitalization.

Between 2020 and 2021, 1 in 5 dead pregnant women did not get access to the ICU, and 1 in 3 who were in the ICU were not intubated, according to data from the OOBr (Brazilian Obstetric Observatory). For obstetrician Rossana Pulcineli Francisco, professor at USP and coordinator of the Brazilian Obstetric Observatory, this factor, associated with the lack of qualified professionals for assistance, was what most contributed to the high mortality rate.

"If an intensivist treats a pregnant woman the same way as other people, the results will not be good. For all parameters [oxygenation, for example], you have to think about the mother and the baby, intensivists, and obstetricians need to work together." From a physiological point of view, during pregnancy, women undergo many changes that can cause a greater inflammatory reaction to Covid. Therefore, right at the beginning of the pandemic, the American CDC warned of the serious risk that the infection posed to pregnant women, with guidelines on proper care.

The Brazilian Ministry of Health also published a guidebook on the subject, but without a network that could closely monitor these women in primary care and refer them to hospitals with ICU beds and trained professionals to assist them, the document was of little use. Historically vulnerable regions suffered the most. "We already predicted a tragedy because we didn't see a maternal-infant network, an adequate health system to assist these women in prenatal care and childbirth. Without a policy to guarantee access, they were wandering through maternity wards, through hospitals", says nurse Brena Gama, a researcher at the Instituto Evandro Chagas, in Belém (PA).

According to doctor Fátima Marinho, senior researcher at Vital Strategies, the high number of maternal deaths is a reflection of the denial of the pandemic and of sexual and reproductive rights in the administration of Jair Bolsonaro. "The lack of national coordination with the states and municipalities left each of us all on our own. There was no collective work to protect pregnant and postpartum women, even though there was already an alert that they represented a higher risk group."

In 2020, only 55% of hospitals that performed legal abortions continued to serve women, according to the Legal Abortion Map. Unsafe abortion is the fourth leading cause of maternal death. Regarding vaccination against Covid-19 in pregnant and postpartum women, the Ministry of Health even made immunization conditional on the presentation of a medical prescription, generating low adherence in this group. According to an analysis by OOBr (Brazilian Obstetric Observatory), pregnant and postpartum women hospitalized with Covid-19 who had previously been vaccinated had a lower risk of needing an ICU (23.5% against 37.4%), intubation (4.8% against 18.8%) and of dying (3% against 14.1%) when compared to those not vaccinated.

Nésio Fernandes, the current secretary of Primary Care at the Ministry of Health, says that the denialist approach given to the pandemic by the Bolsonaro government has meant that risk communication during pregnancy and the postpartum period was underestimated. According to him, the ministry is going to reactivate the maternal and child mortality committees in the Brazilian states and create a network for surveillance and monitoring of care for pregnant and postpartum women, especially in regions with health care gaps.

Former Secretary of Primary Care in the Bolsonaro government, Raphael Câmara said that his administration "was the one that did the most in history regarding the care of pregnant women and babies". "We doubled the funding, going from R$900 million to R$1.8 billion," he said. Câmara also said that his management "funded maternity hospitals", created a "book to treat Covid in pregnant women" and launched "ordinances of more than R$ 1 billion to care for pregnant women".

The series of reporting articles on Maternal Mortality is a partnership with the Pulitzer Center.

Translated by Cassy Dias

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