Maternal mortality and conditions of Maranhão: spatial and temporal analysis before and during the COVID-19 pandemic

Abstract

Objective: To analyze the spatial and temporal distribution of maternal mortality and its relationship with socioeconomic and healthcare-related factors in the municipalities of Maranhão, considering the periods before and during the COVID-19 pandemic. 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 clustering patterns and correlations between the Maternal Mortality Ratio (MMR) and indicators of social vulnerability, Primary Health Care coverage, and adequacy of prenatal care. Results: The MMR showed positive spatial autocorrelation across all analyzed periods, indicating territorial similarity in maternal mortality patterns. A predominance of “Low-Low” clusters was observed, suggesting spatial grouping of municipalities with lower rates. However, during the pandemic, changes in these clustering patterns were identified, reflecting increased inequalities between territories. Conclusion: Despite the challenges posed by COVID-19, some municipalities maintained better maternal health outcomes, likely associated with stronger healthcare infrastructure and broader Primary Health Care coverage. These findings highlight the need to strengthen territorial maternal care policies, reduce inequalities, and enhance the quality of the maternal health care network.