Hypertension‑linked maternal deaths in Brazil are tied to inequality
Maternal deaths from hypertension persist in Brazil, despite being preventable. The conclusion was drawn by researchers from the State University of Campinas (Unicamp), in São Paulo, which analyzed data from 2012 to 2023. The problem, results show, is closely related to inequality.
In the period examined, the average death rate among indigenous women was more than twice that of white women. The rate among black women, in turn, was almost three times higher than among white women.
“There is no biological predisposition to higher mortality from hypertensive disorders during pregnancy in these groups. These women are more likely to live in poverty, have less access to education, and face barriers to accessing quality health care,” the study says.
“Systemic racial bias in the healthcare system can lead to prejudiced treatment and unequal care. In addition, black, pardo, and indigenous women may experience negative interactions with health professionals, which contributes to mistrust in health services and results in worse maternal and perinatal outcomes,” the text adds.
Over the 11-year period, almost 21 thousand women died during pregnancy, childbirth, or the postpartum period. In around 18 percent of cases (3,721 deaths), complications stemmed from hypertension.
This means that Brazil’s overall maternal death rate stood at 61.8 per 100 thousand births—below the 70 limit recommended by the World Health Organization, but well above the rates in developed countries, which usually range from two to five deaths per 100 thousand births.
Pandemic effect
Considering only deaths proven to result from hypertension, the average rate was 11.01 per 100 thousand births, and has remained stable over the years—with the exception of 2023, when it fell to 8.73. Despite the reduction, for the time being, this particular figure is viewed with caution and is considered to be a one-off.
In addition, 2022 saw the highest number of cases proportionally—11.94 deaths per 100 thousand births. The experts believe that this peak was an indirect consequence of the pandemic, which disrupted health services in 2020 and 2021, impacting obstetric care during this period as well as in the following months.
According to José Paulo Guida, professor at Unicamp’s Department of Obstetrics and Gynecology, one of the authors of the study, this demonstrates the importance of quality prenatal care.
“A woman doesn’t die overnight. There are several moments when she can be treated. As soon as a woman finds out she’s pregnant, she should start prenatal care. This may not be the case for women who live further away from urban centers, which is already a barrier to access. Here in Brazil, the average time to start prenatal care is the 16th week—i.e. around the fourth month,” he said.
Prevention
This is a milestone in the management of hypertension, as two accessible and inexpensive drugs can reduce the possibility of complications by 40 percent, as long as they are istered before the pregnancy reaches its 17th week—calcium carbonate and acetylsalicylic acid (ASA, also known as aspirin). In February, the Brazilian Ministry of Health decided to prescribe calcium to all pregnant women and ASA should be used as a complementary measure for those at higher risk.
However, Professor José Paulo Guida stressed that medicines cannot be lacking in health facilities, and professionals throughout Brazil must be trained to correctly identify risk factors and prescribe the medication appropriately.
“At the first appointment, the professional must gather information about her background. What was her previous pregnancy like? Is she really young? Is she old? Is she obese or does she have any illnesses? These are all risk factors for her developing hypertension during pregnancy,” he noted.
The study also found that the proportion of deaths rises dramatically after the age of 40, with the average rate close to 31 deaths per 100 thousand births. According to Professor Guida, women in this age group are more likely to become pregnant while already suffering from health problems, such as hypertension or diabetes, which increases the risk of these conditions becoming serious.
In addition, deaths from hypertension are likely to be even more numerous in reality, since 2,400 women died from hemorrhage in the period analyzed and, as the Unicamp professor explains, hypertension causes the destruction of platelets, making blood clotting more difficult, which can also lead to this outcome.
