{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T15:23:51Z","timestamp":1768317831762,"version":"3.49.0"},"reference-count":59,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Maternal mortality in Brazil remains a critical indicator of social and racial inequalities, reflecting structural failures in access to and quality of obstetric care. Black women, particularly those categorized as black or brown, are at a higher risk of dying during pregnancy, childbirth, or the postpartum period. This is the result of the intersection of institutional racism, poverty, and social vulnerabilities. This study aimed to analyze trends and associated factors of maternal mortality among black women in Brazil from 2000 to 2020. Methods: This is a retrospective cohort analytical study using data from the Brazilian Mortality Information System. The sample included women aged 10 to 49 years whose underlying cause of death was classified under ICD-10 codes O00\u2013O99. Descriptive and bivariate analyses were conducted, as well as Poisson and multinomial logistic regressions to estimate adjusted risk ratios according to skin color, education, region, type, and place of death. Results: A total of 40,907 maternal deaths were identified, with 59.2% occurring among black women. The maternal mortality ratio was 39% higher among black women compared to white women and more than double among Indigenous women. Low education, residence in the North and Northeast regions, deaths outside hospital settings, and lack of formal investigation were independently associated with increased risk. Direct obstetric causes accounted for most deaths, with hypertensive disorders and puerperal complications being the leading conditions. Conclusions: Maternal mortality among black women in Brazil reveals deep structural inequalities. Urgent public policies that incorporate an intersectional perspective, addressing race, gender, and class, are necessary to reduce disparities and ensure equitable and dignified maternal healthcare.<\/jats:p>","DOI":"10.3390\/ijerph23010094","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T16:03:16Z","timestamp":1767974596000},"page":"94","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maternal Mortality Among Black Women in Brazil: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1615-7646","authenticated-orcid":false,"given":"Gustavo Gon\u00e7alves dos","family":"Santos","sequence":"first","affiliation":[{"name":"Escola Paulista de Medicina, Universidade Federal de S\u00e3o Paulo (EPM\/UNIFESP), S\u00e3o Paulo 04023-062, SP, Brazil"},{"name":"Campus Guaruj\u00e1 (UNAERP), Universidade de Ribeir\u00e3o Preto, S\u00e3o Paulo 11440-003, SP, Brazil"},{"name":"Programa de P\u00f3s-gradua\u00e7\u00e3o do Departamento de Ginecologia, Edif\u00edcio Oct\u00e1vio de Carvalho, Rua Botucatu, 740-5\u00ba andar, Sala 508, S\u00e3o Paulo 04023-062, SP, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9471-5175","authenticated-orcid":false,"given":"Anuli","family":"Njoku","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Health and Human Services, Southern Connecticut State University (USCS), New Haven, CT 06515, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1574-3627","authenticated-orcid":false,"given":"Reginaldo Roque","family":"Mafetoni","sequence":"additional","affiliation":[{"name":"Faculdade de Enfermagem, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-887, SP, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1920-3193","authenticated-orcid":false,"given":"Clara Fr\u00f3es de Oliveira","family":"Sanfelice","sequence":"additional","affiliation":[{"name":"Faculdade de Enfermagem, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-887, SP, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6584-0575","authenticated-orcid":false,"given":"Ana Izabel Oliveira","family":"Nicolau","sequence":"additional","affiliation":[{"name":"Centro de Ci\u00eancias da Sa\u00fade, Departamento de Enfermagem, Universidade Federal do Cear\u00e1 (UFC), Fortaleza 60430-160, CE, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9321-7169","authenticated-orcid":false,"given":"Patr\u00edcia Wottrich","family":"Parenti","sequence":"additional","affiliation":[{"name":"Escola de Artes, Ci\u00eancias e Humanidades, Universidade de S\u00e3o Paulo (EACH\/USP), S\u00e3o Paulo 03828-000, SP, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3407-799X","authenticated-orcid":false,"given":"Cely de","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Campus Guaruj\u00e1 (UNAERP), Universidade de Ribeir\u00e3o Preto, S\u00e3o Paulo 11440-003, SP, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3557-375X","authenticated-orcid":false,"given":"Leticia","family":"L\u00f3pez-Pedraza","sequence":"additional","affiliation":[{"name":"Facultad de Enfermer\u00eda, Fisioterapia y Podolog\u00eda, Universidad Complutense de Madrid (UCM), 28040 Madrid, MA, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1284-971X","authenticated-orcid":false,"given":"Ricardo Jos\u00e9 Oliveira","family":"Mouta","sequence":"additional","affiliation":[{"name":"Faculdade de Enfermagem, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro 20551-030, RJ, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9822-7518","authenticated-orcid":false,"given":"Karina Franco","family":"Zihlmann","sequence":"additional","affiliation":[{"name":"Departamento de Sa\u00fade, Educa\u00e7\u00e3o e Sociedade, Universidade Federal de S\u00e3o Paulo-Campus Baixada Santista (UNIFESP\/BS), S\u00e3o Paulo 11060-001, SP, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4578-2224","authenticated-orcid":false,"given":"Cindy Ferreira","family":"Lima","sequence":"additional","affiliation":[{"name":"Organiza\u00e7\u00e3o Pan-Americana da Sa\u00fade (OPAS), Secretaria do Estado de Sa\u00fade de Minas Gerais, Minas Gerais 31630-903, MG, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7871-0761","authenticated-orcid":false,"given":"C\u00edcero Ricarte Beserra","family":"J\u00fanior","sequence":"additional","affiliation":[{"name":"Estrat\u00e9gia Sa\u00fade da Fam\u00edlia do Munic\u00edpio de Senador Pompeu (ESF), Pompeu 63600-000, CE, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6946-0465","authenticated-orcid":false,"given":"Cl\u00e1udia de Azevedo","family":"Aguiar","sequence":"additional","affiliation":[{"name":"Instituto de Ci\u00eancias da Sa\u00fade, Universidade Federal do Tri\u00e2ngulo Mineiro (UFTM\/ICS), Uberaba 38025-180, MG, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4414-3862","authenticated-orcid":false,"given":"Cesar Henrique Rodrigues","family":"Reis","sequence":"additional","affiliation":[{"name":"Programa de P\u00f3s-gradua\u00e7\u00e3o em Enfermagem, Faculdade de Enfermagem, Universidade Federal de Mato Grosso do Sul (UFMS), Tr\u00eas Lagoas 79070-900, MS, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4893-7690","authenticated-orcid":false,"given":"J\u00falia Maria das Neves","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Unidade Cient\u00edfico-Pedag\u00f3gica de Enfermagem de Sa\u00fade Materna, Obst\u00e9trica e Ginecol\u00f3gica (UCP-ESMOG), Escola Superior de Enfermagem de Coimbra (ESEnfC), 3046-851 Coimbra, Portugal"}]},{"given":"Ana Cristina Ribeiro da Fonseca","family":"Dias","sequence":"additional","affiliation":[{"name":"Escola Superior de Sa\u00fade, Universidade dos A\u00e7ores (UAc\/ESS), 9500-315 Ponta Delgada, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1274-7473","authenticated-orcid":false,"given":"Maria Lu\u00edsa Santos","family":"Bettencourt","sequence":"additional","affiliation":[{"name":"Escola Superior de Sa\u00fade, Universidade dos A\u00e7ores (UAc\/ESS), 9500-315 Ponta Delgada, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0548-8829","authenticated-orcid":false,"given":"M\u00f3nica Alexandra Pinho","family":"da Silva","sequence":"additional","affiliation":[{"name":"Escola Superior de Enfermagem do Porto (ESEP), Universidade do Porto, 4200-072 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2510-5955","authenticated-orcid":false,"given":"Maria Jo\u00e3o Jacinto","family":"Guerra","sequence":"additional","affiliation":[{"name":"Escola Superior de Enfermagem do Porto (ESEP), Universidade do Porto, 4200-072 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0070-7044","authenticated-orcid":false,"given":"Giovana Aparecida Gon\u00e7alves","family":"Vidotti","sequence":"additional","affiliation":[{"name":"Escola Paulista de Medicina, Universidade Federal de S\u00e3o Paulo (EPM\/UNIFESP), S\u00e3o Paulo 04023-062, SP, Brazil"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"ref_1","unstructured":"Brasil. 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