Panorama of Two Decades of Maternal Deaths in Brazil: Retrospective Cohort Study

Background: Maternal mortality remains a significant public health challenge in Brazil, reflecting persistent social, racial, and regional inequalities. Objectives: This study aimed to analyze trends and characteristics of maternal deaths in Brazil from 2000 to 2020, identifying sociodemographic and clinical risk factors. Methods: A retrospective population-based cohort study was conducted using secondary data from the Mortality Information System. Descriptive and comparative statistical analyses were performed, stratifying variables such as region, age, ethnicity, education, type and period of death, and investigation status. Results: A total of 40,907 maternal deaths were recorded. Most deaths occurred among young, brown-skinned women with low education levels, particularly in the Southeast and Northeast regions. Direct obstetric causes were predominant, and most deaths occurred in hospital settings. Conclusions: Maternal mortality in Brazil is preventable and deeply influenced by structural inequities. Improving maternal care, enhancing surveillance, and addressing social determinants are critical for meeting Sustainable Development Goals and ensuring reproductive justice.