Healthcare and sociodemographic conditions related to severe maternal morbidity in a state representative population, Federal District, Brazil: A cross-sectional study

BACKGROUND The concept of severe maternal morbidity (SMM)-a potentially life-threatening condition during pregnancy, childbirth or after termination of pregnancy-can be used as a quality indicator of the health care provided to mothers and children. The aim of this study was to investigate the SMM rate and the main factors associated with this condition among women living in the Federal District, Brazil. METHODS We conducted a cross-sectional population-based sample survey using a structured questionnaire about the sociodemographic characteristics of the participants' families. The data investigated included receipt of financial aid from the Federal Government, age, race, maternal educational level, prenatal care, mode of delivery, and serious complications during pregnancy and postpartum (SMM). 1042 mothers of children up to 1 year old were interviewed, representing a weighted estimated population of 36,724 mothers. The sample was representative of the whole Federal District state. RESULTS Mothers were between 19 and 34 years old (69%), most of them were brown or black (59.7%), and they had more than 9 years of education (81.2%). Prenatal care was adequate for 91.9% of them, the most common mode of delivery was Cesarean section (61.3%), and most deliveries took place in public hospitals (57.3%). The prevalence of low birth weight (< 2,500 g) was 8.1%. We found 2072 events of SMM in 2060 mothers (SMM rate: 5.6%). There was an association between higher occurrence of SMM and older age (OR: 1.40; 1.26-1.56), lower maternal educational level (OR: 3.29; 2.78-3.90), and inadequate prenatal care (OR: 1.28; 1.09-1.51). Receipt of financial aid was also associated to increased risk for SMM (OR: 1.31; 1.16-1.48). Cesarean section and low birth weight reduced the risk of SMM (decrease of 49.0% and 46.0%, respectively). CONCLUSIONS The SMM rate in the Federal District was positively associated with higher maternal age, lower maternal educational level, inadequate prenatal care, and government financial aid program. Conversely, SMM was inversely associated with Cesarean delivery and low birth weight. This study showed that specific demographic groups are at higher risk for SMM. Therefore, actions should be focused primarily on those groups for greater effectiveness at reducing maternal mortality and providing better quality of maternal health care.