[Distance between place of residence and location of maternal deaths: Regional, ethnic-racial, and territorial inequalities in Brazil, 2018 to 2023Distancia entre la zona de residencia de las mujeres parturientas y el lugar donde se producen las muertes maternas: desigualdades regionales, étnico-raciales y territoriales en Brasil, 2018-2023].

Abstract

Objective: To analyze the distance between the place of residence and the location of maternal deaths in Brazil from 2018 to 2023, taking into account territorial, ethnic-racial, and regional inequalities.

Methods: An ecological study was conducted using data from Brazil's Mortality Information System (SIM) and the Live Birth Information System (Sinasc). Distances between the municipalities of residence and those where maternal deaths occurred were calculated using the Open Source Routing Machine (OSRM) API. The maternal mortality ratio (MMR), defined as the number of maternal deaths per 100 000 live births, was estimated according to distance intervals, race/skin color, age group, pandemic period, and municipal population size.

Results: A total of 10 911 maternal deaths were recorded in Brazil during the study period. The majority (56.7%) occurred without inter-municipal travel. Travel distances greater than 500 km were more frequent among indigenous women and women under 20 years of age. In these cases, the MMR was higher, reaching 772.5 deaths per 100 000 live births during the COVID-19 pandemic (2020 and 2021). Among indigenous women, the average travel distance was the highest across all groups, reaching 533 km in 2020 and 2021. Municipalities with fewer than 50 000 inhabitants accounted for 58.2% of inter-municipal travel.

Conclusions: Travel distances were longer in contexts of greater social and territorial vulnerability, such as among indigenous women and residents of less populated areas. The findings underscore the need for public policies that address territorial inequalities and expand geographic access to ensure safe and timely obstetric care.