Chart 1. Indicators available on the “Maternal health surveillance” panel, with respective calculation method, source of information, and reference value.
| Indicator | Calculation method | Source of information | Reference value |
|---|---|---|---|
| Block 1 - Socioeconomic conditions and access to health services | |||
| MHDI | Dimensions of the Global HDI (longevity, education, and income), adapting the methodology to the Brazilian context and the availability of national indicators. | Atlas Brasil | 0.00-0.499=very low; 0.500-0.599=low; 0.600-0.699=medium; 0.700-0.799=high; 0.800-1.00=very high 18 |
| Percentage of LB according to mother’s age range | Number of LB by maternal age divided by total LB and multiplied by 100. | SINASC | National average |
| Percentage of LB according to mother’s race/color | Number of LB by maternal skin color divided by total LB and multiplied by 100. | SINASC | National average |
| Percentage of LB according to mother’s education | Number of LB by maternal education divided by total LB and multiplied by 100. | SINASC | National average |
| Percentage of women aged 10 to 49 years who are exclusive users of SUS | (Female population aged 10 to 49 years minus female population aged 10 to 49 years benefiting from medical insurance) divided by the female population aged 10 to 49 years and multiplied by 100. | ANS, IBGE | National average |
| Population coverage with family health teams | Annual average of the population assisted by family health teams divided by the total population of the municipality and multiplied by 100. | SIAB | 95% (SDG)* 11 |
| Block 2 - Reproductive planning | |||
| Specific fertility rate in women under 20 years of age | Number of LB of women under 20 years old divided by the female population aged 10 to 19 years old and multiplied by 1,000. | SINASC, IBGE | <30 per 1,000 (developed countries) 15 |
| Percentage of multiparous women | Number of LB of women with >3 previous births divided by total LB and multiplied by 100. | SINASC | National average |
| Unsafe abortion rate per 1,000 women of childbearing age 19 | Number of hospitalizations for abortion in public and private services multiplied by the correction factor for hospitalizations for spontaneous abortion and for induced abortions without hospital admission divided by the female population aged 10 to 49 years and multiplied by 1,000. | SIH/SUS, ANS, IBGE | National average |
| Unsafe abortion ratio per 100 LB 19 | Number of hospitalizations for abortion in public and private services multiplied by the correction factor for hospitalizations for spontaneous abortion and for induced abortions without hospital admission divided by total LB and multiplied by 100. | SIH/SUS, ANS, SINASC | National average |
| Block 3 - Prenatal care | |||
| Prenatal care coverage | Number of LB of mothers with any prenatal consultation divided by total LB and multiplied by 100. | SINASC | 95% (WHO recommendation)† 9 |
| Percentage of women starting early prenatal care | Number of LB of mothers who started prenatal care in the first trimester of pregnancy divided by total LB and multiplied by 100. | SINASC | 95% (WHO recommendation)† 9 |
| Percentage of women with more than seven prenatal consultations | Number of LB of mothers with >7 prenatal consultations divided by total LB and multiplied by 100. | SINASC | 95% (WHO recommendation)† 9 , 12 |
| CS incidence rate | Number of CS cases in <1 year divided by total LB and multiplied by 1,000. | SINAN, SINASC | ≤0.5 per 1 thousand LB (international goal) 9 |
| Block 4 - Delivery assistance | |||
| Percentage of births by cesarean section | Number of LB per cesarean section divided by total LB and multiplied by 100. | SINASC | 10-15% (WHO reference) 13 |
| Percentage of births according to Robson group | Number of LB per Robson group divided by total LB and multiplied by 100. | SINASC | National average |
| Percentage of births by cesarean section in each Robson group | Number of LB by cesarean section in each Robson group divided by total LB in each Robson group and multiplied by 100. | SINASC | Group 1=10%; Group 2=20 to 35%; Group 3=3%; Group 4=15%; Group 5=50 to 60%; Group 10=30% (WHO reference) 14 ; Groups 6 to 9=national average. |
| Relative contribution of each Robson group to the total cesarean section rate | Number of LB by cesarean section in each Robson group divided by total LB per cesarean section and multiplied by 100. | SINASC | National average |
| Percentage of births according to place of occurrence | Number of LB per birth location divided by total LB and multiplied by 100. | SINASC, CNES | National average of births occurring in the municipality of residence |
| Median travel for births occurring outside the mother's municipality of residence according to complexity of the birth care service | Median travel in kilometers between the geographic coordinate of the urban perimeter of the mother’s municipality of residence and that of the municipality in which the birth occurred. Complexity of the service defined according to adult ICU bed availability registered in CNES. | SINASC, CNES | No reference standard‡ |
| Block 5 - Birth conditions | |||
| Percentage of births with low birth weight | Number of LB with birth weight <2,500 g divided by total LB and multiplied by 100. | SINASC | 30% reduction by 2025 in relation to values observed in 2006-2010 (international goal) 10 |
| Percentage of preterm births | Number of LB with GA <37 weeks divided by total LB and multiplied by 100. | SINASC | 10% (developed countries) 16 |
| Percentage of early term births | Number of LB with GA 37 or 38 weeks divided by the total LB and multiplied by 100. | SINASC | 20% (developed countries with a low percentage of cesarean births) 17 |
| Block 6 - Maternal mortality and morbidity | |||
| Number of maternal deaths | Total number of maternal deaths after investigation. | SIM | No reference standard§ |
| MMR | Number of maternal deaths divided by total LB multiplied by 100,000. | SIM, SINASC | <30 per 100,000 live births (Brazil SDG) 11 |
| Percentage of maternal deaths due to direct obstetric causes | Number of maternal deaths from direct obstetric causes divided by the total number of maternal deaths multiplied by 100. | SIM | National average |
| Percentage of direct maternal deaths due to specific causes | Number of maternal deaths from specific direct obstetric causes (abortion, hypertension, hemorrhage, and infections) divided by the total number of maternal deaths from direct obstetric causes multiplied by 100. | SIM | National average |
| Percentage of obstetric hospitalizations classified as severe maternal morbidity | Number of SMM cases divided by the total number of public obstetric hospitalizations multiplied by 100 | SIH/SUS | National average |
| Percentage of cases of severe maternal morbidity according to specific causes | Number of SMM cases according to cause (hypertension, hemorrhage, infection) divided by the total number of SMM cases in public obstetric hospitalizations multiplied by 100. | SIH/SUS | National average |
| Percentage of SMM cases according to management indicators | Number of SMM cases according to management indicator (transfusion, surgery, ICU admission, ALS >7 days) divided by the total of SMM cases in public obstetric hospitalizations multiplied by 100. | SIH/SUS | National average |
| Quality of information | |||
| SINASC Coverage | Number of LB in SINASC divided by the estimated number of births multiplied by 100. | IBGE | 90% 7 |
| SIM coverage | Number of deaths in SIM divided by the estimated number of deaths multiplied by 100. | IBGE | 90% 7 |
| Percentage of deaths of women of childbearing age investigated | Number of WCA deaths investigated divided by total WCA deaths and multiplied by 100. | Tabnet SIM | 90% (national goal) 20 |
| Percentage of maternal deaths investigated | Number of maternal deaths investigated divided by the total number of maternal deaths and multiplied by 100. | Tabnet SIM | 100% (national goal) 20 |
| Degree of incompleteness | Number of variables with blank or missing records divided by total LB and multiplied by 100. | SINASC | <5% 8 |
MHDI: Municipal Human Development Index; HDI: Human Development Index; LB: live births; SINASC: Live Birth Information System (Sistema de Informação sobre Nascidos Vivos); ANS: National Supplementary Health Agency (Agência Nacional de Saúde Suplementar); IBGE: Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística); SIAB: Primary Care Information System (Sistema de Informação da Atenção Básica); SIH/SUS: Hospital Information System of the Unified Health System (Sistema de Informações Hospitalares do Sistema Único de Saúde); WHO: World Health Organization; CS: congenital syphilis; SINAN: Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação); GA: gestational age; CNES: National Registry of Health Establishments (Cadastro Nacional de Estabelecimentos de Saúde); SIM: Mortality Information System (Sistema de Informação sobre Mortalidade); MMR: Maternal Mortality Ratio; SDG: Sustainable Development Goals; SMM: severe maternal morbidity; ICU: Intensive Care Unit; ALS: average length of stay;
WCA: woman of childbearing age.
*The SDG’ aim is universal coverage of the population with basic care. We chose the reference value of 95% due to the possibility of error in population estimates. In municipalities with high health insurance coverage, coverage with family health teams must cover at least the percentage of the population that depends exclusively on SUS; †95% is the value recommended by the WHO for process indicators to prevent vertical transmission of syphilis and HIV. The same value was adopted for prenatal indicators; ‡due to the great Brazilian diversity, we chose not to define a national reference value. In general, the higher the median displacement, the greater the probability of delay in delivery care; §reference value not applicable.