Geographic accessibility to obstetric care and maternal mortality in a large metropolitan area of Brazil.
OBJECTIVE
To assess maternal mortality and its association with accessibility to obstetric care in the metropolitan region of Rio de Janeiro, Brazil.


METHODS
Maternal mortality was assessed from 2 national databases, one administrative and the other designed for epidemiologic purposes. Distances traveled from residence to hospital via the transit network were calculated using a specialized information system. Deaths were grouped by area of residence, and maternal mortality ratios (number of deaths per 100,000 live births) as well as death incidence ratios (deaths/live births in 2 regions or hospital types) were calculated for these areas.


RESULTS
We identified 236 deaths and estimated under-reporting at 30%. The most common causes of death were hypertension-related disorders, "other obstetric conditions," and complications from abortion; the longest traveled distance was 66.43 km (mean, 13.65 km); and maternal mortality ratios varied between 25.54% and 56.45%, the highest values being for areas with the lowest municipal human development index. The highest death incidence ratios were found at general hospitals without specialized obstetric care.


CONCLUSIONS
Maternal mortality is still a serious problem in the studied region. The wide variations among areas of different socioeconomic conditions suggest the need for a better allocation of health care resources.
Programa de Engenharia Biomédica-COPPE, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Patrícia P
PP
Simões
Renan M V R
RM
Almeida
D000293:Adolescent; D000328:Adult; D001938:Brazil; D016208:Databases, Factual; D005260:Female; D040362:Geographic Information Systems; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008428:Maternal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D012959:Socioeconomic Factors; D055815:Young Adult