MORTALIDADE MATERNA E DETERMINANTES DOS MUNICÍPIOS NORDESTINOS: ANÁLISE ESPACIAL ANTES E DURANTE A PANDEMIA DE COVID-19

Abstract

Objective: To analyze the spatial distribution of maternal mortality in Northeast Brazil before and during the COVID-19 pandemic, correlating the Maternal Mortality Ratio (MMR) with social vulnerability and maternal healthcare indicators. Methods: This is an ecological and analytical study based on secondary data from 2017 to 2022. Global and Local Moran spatial autocorrelation indices were applied to identify territorial patterns and risk clusters. Correlation analyses were also conducted between the Maternal Mortality Ratio (MMR), social vulnerability indicators, Primary Health Care coverage, and adequacy of prenatal care. Analyses were performed for all municipalities in Northeast Brazil. Results: At the regional level, positive spatial autocorrelation of MMR was observed in all analyzed periods. Before the pandemic, the Global Moran’s I was 0.140, increasing to 0.234 during the pandemic period (2020–2022), indicating that maternal mortality is not randomly distributed across the territory. Low–Low clusters predominated, representing municipalities with lower mortality rates. However, during the COVID-19 pandemic, changes in the spatial configuration of these clusters were observed, with increased inequalities and greater territorial heterogeneity. In Maranhão, spatial patterns showed greater instability during the pandemic, with more pronounced changes in cluster distribution and stronger associations between maternal mortality, social vulnerability, lower Primary Health Care coverage, and inadequate prenatal care. Conclusion: Despite the challenges imposed by the COVID-19 pandemic, some municipalities in Northeast Brazil maintained more favorable maternal mortality patterns, possibly related to better healthcare infrastructure and more organized Primary Health Care systems. In Maranhão, however, territorial inequalities were more pronounced, reinforcing the need to strengthen maternal health policies, improve maternal death surveillance, and enhance healthcare networks with a territorial and equity-focused approach.