title: Temporal evolution and spatial distribution of maternal death.
abstract: OBJECTIVE
  To analyze the temporal evolution of maternal mortality and its spatial distribution.
  
  
  METHODS
  Ecological study with a sample made up of 845 maternal deaths in women between 10 and 49 years, registered from 1999 to 2008 in the state of Rio Grande do Sul, Southern Brazil. Data were obtained from Information System on Mortality of Ministry of Health. The maternal mortality ratio and the specific maternal mortality ratio were calculated from records, and analyzed by the Poisson regression model. In the spatial distribution, three maps of the state were built with the rates in the geographical macro-regions, in 1999, 2003, and 2008.
  
  
  RESULTS
  There was an increase of 2.0% in the period of ten years (95%CI 1.00;1.04; p = 0.01), with no significant change in the magnitude of the maternal mortality ratio. The Serra macro-region presented the highest maternal mortality ratio (1.15, 95%CI 1.08;1.21; p < 0.001). Most deaths in Rio Grande do Sul were of white women over 40 years, with a lower level of education. The time of delivery/abortion and postpartum are times of increased maternal risk, with a greater negative impact of direct causes such as hypertension and bleeding.
  
  
  CONCLUSIONS
  The lack of improvement in maternal mortality ratio indicates that public policies had no impact on women's reproductive and maternal health. It is needed to qualify the attention to women's health, especially in the prenatal period, seeking to identify and prevent risk factors, as a strategy of reducing maternal death.
authors.affiliation: Centro de Ciências Biológicas e da Saúde, Centro Universitário Univates, Lajeado, RS, Brasil.
authors.forename: Ioná
authors.initials: I
authors.lastname: Carreno
authors.affiliation: Universidade Federal do Rio Grande do Sul, RS, Brasil.
authors.forename: Ana Lúcia de Lourenzi
authors.initials: AL
authors.lastname: Bonilha
authors.affiliation: Universidade do Vale do Rio dos Sinos, RS, Brasil.
authors.forename: Juvenal Soares Dias da
authors.initials: JS
authors.lastname: Costa
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D004522:Educational Status; D005260:Female; D006801:Humans; D008428:Maternal Mortality / Q000639:trends*; D008875:Middle Aged; D016012:Poisson Distribution; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D012111:Residence Characteristics; D012307:Risk Factors; D014505:Urban Population; D055815:Young Adult