Maternal Mortality Underreporting in Brazil Due to Coding Errors (2010-2021)

Area of Science:

• Public Health
• Epidemiology
• Demography

Background:

• Accurate tracking of maternal deaths is crucial for global health resource allocation.
• Preventable maternal mortality remains a significant global health challenge.
• The Brazilian maternal death coding system's accuracy requires evaluation.

Purpose of the Study:

• To assess the accuracy of Brazil's maternal death coding system.
• To compare the official maternal mortality ratio (MMR) with a recalculated MMR.
• To identify factors associated with underreported maternal deaths in Brazil.

Main Methods:

• Retrospective observational study analyzing mortality data from 2010 to 2021.
• Inclusion of officially reported maternal deaths and uncoded deaths of women aged 10-49 with pregnancy-puerperal status.
• Recalculation of the maternal mortality ratio (MMR) incorporating reclassified deaths.

Main Results:

• Brazil recorded 21,670 official and 3,480 uncoded maternal deaths (2010-2021).
• Including reclassified deaths increased the median MMR from 58.2 to 67.5 per 100,000 live births.
• Uncoded deaths were more common in women with lower education, extreme ages, indirect causes, and fewer investigations.

Conclusions:

• Brazil's maternal death coding system underreports actual maternal mortality.
• Improved coding practices are essential to accurately capture maternal deaths.
• Addressing underreporting is vital for effective maternal mortality reduction strategies.