Greater Lisbon – where problems are chronic – shows highest percentage of deaths
Following increasingly worrying numbers as Portugal’s obstetric care flounders through lack of specialist doctors, new data on fetal and neonatal deaths for 2023 and 2024 pinpoints Greater Lisbon as the absolute ‘blackspot’ for bad births.
While 847 fetal and neonatal deaths were recorded on the mainland over the two years, 399 of them happened in the Greater Lisbon area – the region of the country where hospital A&E/ obstetric emergency services are in the most dramatic situation, with periodic closures regularly being announced through the press.
Today’s data comes from monitoring by the ERS (health regulatory authority) which indicates that 0.52% of babies due between 2023 and 2024 ended up as either fetal or neonatal deaths.
2023 saw 426 fetal (before birth) deaths and 28 neonatal (when the infants survived for less than 28 days).
Numbers dropped slightly in 2024, to 421. But the reality is that the highest proportion of these tragedies (for the families involved) occurred within the Greater Lisbon area.
This study follows ERS’ findings last year, showing that fetal and neonatal deaths in Greater Lisbon had DOUBLED in 2023.
Experts called in to comment at the time were keen to deflect any connection with the frenetic opening and closing of maternity units. They stressed that “context” was needed “to understand the data”.
Pediatrician Alberto Caldas Afonso of the commission for women’s, children’s and adolescent health, suggested possible two explanations: one being that the majority of ‘at risk’ births choose Lisbon/ Porto for their maternity care, another that there are a large number of children being born these days to ‘non-Portuguese’ who often turn up at maternity units with no records to show the medical accompaniment they may have had during their pregnancies.
It is unclear whether these kind of hypotheses will still be considered. State news agency Lusa simply states what the latest study shows: “The percentage of deaths per birth in Greater Lisbon (0.70%) is much higher than those recorded in the North (0.44%), in the Center (0.42%), in the West and Tejo Valley (0.27%), in the Setúbal Peninsula (0.40%), in the Alentejo (0.32) and in the Algarve (0.48%).”
ERS also states that the most frequently identified expressions in the responses from obstetrics and neonatology units regarding fetal deaths that occurred in 2024 were ‘placental insufficiency’, ‘placental abruption’ and ‘intrauterine infection’.
In the case of neonatal deaths, the units’ responses most frequently pointed to situations of extreme prematurity, hypoxemia, and congenital anomalies, according to the regulatory entity’s monitoring, which does not include data on users’ access to obstetric A&E departments, and the SNS Grávidas line, which will be evaluated in a later study.
According to ERS, in 2024, there were 56 obstetrics and neonatology units in mainland Portugal during the years under evaluation, the majority of which (69.6%) belonged to the SNS National Health Service.
The 56 units performed more than 80,000 births that year – a slight reduction compared to the more than 81,000 the previous year.
Between 2023 and 2024, there was a 1.1% decrease in the total number of births in mainland Portugal – a trend explained by the reduction recorded in the Setúbal Peninsula (-11.9%), in the Center (-4.9%), in the North (-2.6%) and in the Algarve (-1.9%).
In 2024, a total of 31,035 cesarean sections were performed, of which 21,073 (67.9%) in SNS units and 9,962 (32.1%) in the social and private sectors.
Regarding the classification of cesarean sections – scheduled, urgent, or emergent –, in 2023 and 2024, urgent sections were the most frequently performed, but the ERS once again highlights that, in private and social sector units, scheduled sections predominated (57.3%), while in the SNS, urgent sections prevailed (65.9%).
In the analysis of users’ access to obstetric healthcare (births), which considered the 56 obstetric and neonatology units in 2024, ERS concludes that 23.3% of women of childbearing age had a low level of access to obstetric healthcare, concentrated mainly in the North (5.8%), West and Tejo Valley (5.4%) and Center (4.8%) regions.
This percentage rose to 32.3% just considering the provision of care by the SNS, according to ERS, which states that more than 80% of births in Portugal took place in SNS hospitals/ health units.
Curiously, there is no mention of the growing numbers of infants born in ambulances. This may be because their births are only registered once they arrive at a hospital.
Source material: LUSA
