35% of Brazilian communities have failed to support pregnant women – 17/03/2023 – Science and Health

Although Brazil has pursued public policies focused on maternal and child health for more than a decade, it has failed to reduce racial and regional inequalities related to maternal deaths, which have been reported during the Covid-19 -pandemic were exacerbated.

One of the major obstetric complications leading to maternal death is hypertension (pre-eclampsia and eclampsia), which has increased their involvement in deaths. In 2014, the rate was 25.2 per thousand births. In 2021, it rose to 33.3 (up 34%). “The best solution to reduce these deaths is to invest in basic care and efficient prenatal care,” says Agatha Eleone.

Meeting the goal of six prenatal consultations comes with some funding for primary care under the Previne Brasil program, but 35% of Brazilian communities have not met that goal in 2022, according to data from Impulso Gov.

Boa Vista in Roraima was one of them. In the first two years of the pandemic, the city also had the highest fatality rate of pregnant and postpartum women hospitalized by Covid (47.7%), according to an analysis by the OOBr (Brazilian Obstetric Observatory). Second is Palmas in Tocantins with 31% and Rio Branco in Acre with 29.4%. The national average was 9.4%.

“These pregnant women went through the emergency room and went straight to the intensive care unit in very critical conditions. Were we prepared? No, we weren’t. The maternity hospital does not have an intensive care unit and there were times [at HGR, Hospital Geral de Roraima] when we looked at the patients, looked at the crowding and said, ‘Where do we put the next one’? recalls Helinana Barros Machado Machado, an intensive care nurse at HGR. According to Gabrielle Almeida Rodrigues, Technical Manager for Women’s Health in Boa Vista, the high death rate in 2021 was related to Covid: of the 28 deaths recorded in the capital, 21 were due to complications from the infection.

We have only one public maternity hospital in the state, and we have no maternal intensive care units. Today it works precariously in an improvised place. Aside from not being a suitable place, it suffers from a severe lack of professionals. That is the main obstacle.” Roraima has 15 parishes, but only Boa Vista has a maternity hospital and a single highly complex public hospital. All serious cases from the country are referred to the capital, in addition to those of Venezuelan and indigenous pregnant women The state-related maternal mortality rate in the country in 2021 is at 282 deaths per 100,000 live births, at a similar level to African countries.

“Demand has grown significantly with immigration. We have increased the number of professionals and the exams, but it is never enough,” says Rodrigues. According to her, in addition to hiring and investing in professional skills, the municipality has created new basic health units and expanded the existing ones. 31 weeks pregnant, Venezuelan Genny, 22, an indigenous Warao woman, had her first prenatal consultation at a UBS in Boa Vista last month. It is her third pregnancy and the first to be monitored thanks to a partnership between UBS and UNFPA (United Nations Population Fund). “I liked it,” she summed up as she left the office and heard the baby’s heartbeat.

In a statement, the Roraima Health Department said that the state is seeing a sharp increase in the demand for maternal and child care and that the main challenge facing the Hospital Materno-Infantil Nossa Senhora de Nazareth is to guarantee assistance to Venezuelan women who are without prenatal follow-up and come to the ward with a high-risk clinical condition. In 2022 there were 7,272 general visits to Venezuelan women with 2,329 deliveries.

In total, the maternity hospital performs around 50,000 births per year. The department also says that the construction of the new maternity hospital is nearing completion and that, in addition to the expansion of the Délio de Oliveira Tupinambá Hospital, there are projects to build a unit in the western part of Boa Vista, the most populated part of the capital , in Pacaraima, on the border with Venezuela.

Nésio Fernandes, secretary for primary care at the Ministry of Health, says that the goal of reducing maternal mortality by 2030 is achievable as long as investments are made in the mother-child network in a short period of time.

“All the diagnoses have already been made. What matters now is a series of structuring decisions that will bring investment to the health regions. According to him, the conditions that lead to maternal death go far beyond what can be done in primary care. They require a hospital structure with capillarity of birthing beds, obstetrics and neonatal intensive care units across the country,” Fernandes explains that the Federal administration developed a cycle of strategic and cross-sectoral planning to define the allocation during this first half of the year. However, the changes to the Rede Cegonha program and the associated investment amounts should not be announced until the second half, according to the secretary of the department.

The series of reporting articles on maternal mortality is a partnership with the Pulitzer Center.

Translated by Cassy Dias

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35% of Brazilian communities have failed to support pregnant women – 17/03/2023 – Science and Health

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