The Impact of the COVID-19 Pandemic on Trends in Stillbirths, Under-5 and Maternal Mortality in Brazil

Background: The COVID-19 pandemic has had direct and indirect impacts on population health indicators. We assessed the impact of the COVID-19 pandemic on national and regional trends and differences in stillbirths, under-5 and maternal deaths in Brazil.Methods: We used the nationwide routine health information system data from January 2017 to December 2021, to which we applied descriptive and advanced mixed effects ordinary least squared regression models to measure the percentage change in mortality levels due to the COVID-19 pandemic. We carried out counterfactual analyses comparing the observed and expected mortality levels for each type of mortality at national and regional levels.Findings: Stillbirths and most noticeably maternal deaths have increased over the COVID-19 period, while an opposite pattern was observed in under-5 mortality, which dropped -11·1% (95%CI: -13·6; -8·7). The percentage increases in stillbirths and maternal deaths were 3·2% (95%CI: 0·6; 5·7) and 38·8% (95%CI: 21·8; 55·8), respectively. We found regional disparities, with higher mortality toll in the North and Central-West regions, contrary to the Southeast region. The observed maternal mortality level has almost doubled compared to the expected number of deaths in a few regions.Interpretation: In Brazil, the COVID-19 outbreak and resulting restrictions negatively affected stillbirths and maternal deaths. We found differences according to the regions of the country, highlighting existing health inequalities.Funding: This study was supported by a grant of the Bill & Melinda Gates Foundation to the Countdown to 2030 for Women’s, Children’s and Adolescents’ Health, through US Fund for UNICEF (Grant Number INV-001299). AM receive support from the Brazilian National Research Council (CNPq), Brazil and São Paulo Research Foundation (FAPESP, grant number 2020/07730-8).Declaration of Interest: The authors declare that there is no conflict of interest.Ethical Approval: In accordance with article 1 of resolution 510/2016 of the National Research Ethics Commission, the study did not require approval from the Research Ethics Committee for using exclusively secondary data of public access, and without the possibility of identifying individuals.