Racial Inequalities in Maternal Mortality in Brazil Between 2000 and 2023: A Retrospective Cohort Study

Background/Objectives: In Brazil, its rates remain persistently high and disproportionate, highlighting severe racial and social inequities that predominantly affect the Black population. The objective is to analyze racial inequalities in maternal mortality in Brazil (2000–2023), identifying sociodemographic, regional, clinical and temporal patterns, with an emphasis on the impact on Black women. Methods: A retrospective population-based cohort study was conducted using data from Brazil's Mortality Information System between 2000 and 2023. A total of 40,907 maternal deaths among women aged 10–49 years were included. Maternal mortality ratios were calculated, and adjusted Poisson regression models were used to examine associations between maternal mortality and race/skin colour, age, education level and region of residence. Results: Black and Brown women accounted for 59.2% of maternal deaths and experienced a significantly higher risk of maternal mortality than White women, while Indigenous women had more than twice the risk. Lower educational attainment, residence in the North and Northeast regions, and maternal age ≥40 years were also independently associated with increased mortality risk. Direct obstetric causes accounted for 65.9% of maternal deaths, with hypertensive disorders and childbirth-related complications among the most frequent causes. The immediate postpartum period represented the highest-risk period, accounting for 47% of deaths. More than half of women had no more than primary-level education, and 50.3% were single. Conclusions: Maternal mortality in Brazil remains characterised by substantial racial, educational and regional inequalities. Indigenous, Black and Brown women, women with lower educational attainment, and those residing in the North and Northeast regions experienced disproportionately higher mortality risks. These findings highlight the need for targeted public health and maternity care interventions to reduce preventable maternal deaths and improve equity in maternal health outcomes.