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Omissão que causa mortes

Segundo estudos da ONU, cerca de 287 mil mulheres morrem diariamente no mundo por problemas relacionados à gravidez. São quase 800 casos por dia, sendo que 90% das mortes de mulheres grávidas poderiam ser evitadas com o atendimento adequado. No Brasil, de acordo com o Ministério da Saúde, mais de 70% das mortes maternas são decorrentes de omissões, intervenções ou tratamentos incorretos ou, ainda, uma cadeia de eventos resultantes e relacionados a essas causas. As mortes são mais frequentes em países em desenvolvimento, o que evidencia o lado cruel da saúde destinada às populações mais pobres.

A Organização Mundial da Saúde (OMS) considera a mortalidade materna como a morte ocorrida durante a gestação ou até 42 dias após o parto, não importando a duração ou a localização da gravidez, morte causada ou agravada pela gravidez. Ainda de acordo com a OMS, a morte materna tardia é aquela ocasionada ou agravada pela gestação, que pode acontecer num período superior a 42 dias depois do parto e inferior a um ano após o parto. A Organização considera aceitável o índice de 20 mortes maternas para cada 100 mil nascidos vivos; entre 20 e 49 mortes, o índice é considerado médio; entre 50 e 149 mortes é alto; e acima de 150, muito alto. No Brasil, a taxa oficial de mortalidade materna é de 75 mortes de mulheres para cada 100 mil nascidos vivos. No entanto, esse número não reflete a realidade, já que nem todas as mortes são registradas como tendo causas relacionadas à gravidez ou ao parto. “A cada óbito notificado, há pelo menos um que ninguém fica sabendo”, afirma a pesquisadora Ana Cristina Tanaka, da Faculdade de Saúde Pública da Universidade de São Paulo (USP).

| Causas

No Brasil, nas motivações da mortalidade materna predominam as causas obstétricas diretas (67%), principalmente as hipertensivas e as síndromes hemorrágicas. Estas são também as mais frequentes na América Latina. Os abortos inseguros, que provocam complicações, possivelmente são foco de subinformação por questões legais ou culturais. Eles estão entre as mortes maternas por causas obstétricas diretas e sua incidência é alta em alguns estados, apesar de ser descriminalizado em casos de estupro e de risco de morte à mulher. Vale ressaltar que a OMS considera o aborto inseguro uma das causas de mortalidade materna mais facilmente evitáveis.

| Soluções

A grande quantidade de cesarianas e a negligência em alguns cuidados durante o pré-natal, como medir a pressão arterial das gestantes, estão entre os fatores que retardam a queda da mortalidade materna no Brasil. É o que aponta a especialista em saúde pública da Universidade Federal da Bahia, Estela Aquino. Apesar de mais de 90% dos partos serem feitos em hospitais, a pesquisadora cita a falta de assistência adequada na hora do parto, obrigando as grávidas a buscar leitos nas maternidades às vésperas do nascimento do filho. “O fenômeno da peregrinação das mulheres no momento de ter um bebê é grande. Temos uma excessiva medicalização (abuso das cesarianas) e a falta do uso de outras tecnologias, como medir a pressão arterial, uma coisa simples que não tem sido feita e que causa impacto na taxa. A mortalidade materna é uma violação de direitos. São mortes, quase em sua totalidade, evitáveis”, afirma.

O movimento das mulheres tem sido o maior protagonista da luta pela redução da mortalidade materna, atuando na conscientização das mulheres e também agindo politicamente junto a poderes constituídos nos âmbitos local, nacional e internacional. Para reduzir a mortalidade materna é necessário que sejam implantadas políticas de governo e políticas públicas, a fim de que haja uma estruturação efetiva do sistema de saúde. Todas as gestantes devem ter assegurado seu direito ao acompanhamento pré-natal, a uma boa assistência no parto e no pós-parto. Além disso, nas situações de aborto, as mulheres precisam contar com um atendimento humanizado.

Os profissionais de saúde também precisam ser qualificados e sensibilizados sobre a importância da assistência, do registro e da análise dos dados pessoais das mulheres atendidas. Somente com o empenho de todos será possível diminuir a taxa de mortalidade materna e atingir a meta da ONU, que é de reduzir 5,5% do total por ano no mundo.

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