Maternal deaths soar in pandemic

The coronavirus pandemic has taken a devastating toll on pregnant women in SA, triggering a 40% increase in maternal deaths and a 10% increase in stillbirths in the year to April 2021, research published in the SA Health Review shows.

The trend reverses hardwon gains in maternal health in SA, which in the decade before Covid-19 saw a steady decline in deaths among women before, during and immediately after childbirth.

Around the world, Covid has dealt pregnant women a double blow: pregnancy increases the risk of severe disease, yet access to health services has been severely disrupted.

“What we have seen is that urban areas were overwhelmed with Covid-19, women booked in late for their first antenatal visits, there was a decline in prescriptions for contraceptives, and a decline in attendance at termination of pregnancy clinics,” said Priya Soma-Pillay, head of obstetrics and gynaecology at the University of Pretoria and Steve Biko Academic Hospital, and co-author of a chapter on maternal health in

the SA Health Review 2021. “At the same time, many women who were from rural areas went back [there] and services were overburdened in those area,” Soma-Pillay said.

SA’s first Covid-19 case was identified in early March 2020, and the country experienced two waves of infection in the next 12 months.

The pandemic began shortly before the start of the 2020/ 2021 fiscal year on April 1 2020, so comparing data from 2019/2020 and 2020/ 2021 provides a gauge of the effect of the pandemic on maternal health.

The researchers included direct deaths during pregnancy and immediately after childbirth (such as a postpartum haemorrhage), and indirect deaths (such as death caused by Covid-19), but excluded incidental deaths (such as a car accident).

They found the number of maternal deaths rose from 920 in 2019/2020 to 1,273 in 2020/ 2021. During this period, the institutional maternal mortality ratio (iMMR) rose 37%, from 88 per 100,000 live births in 2019/2020 to 120.9 per 100,000 live births in 2020/ 2021. The iMMR reflects women giving birth in health facilities and is routinely monitored worldwide to gauge the strength of a health system. The sharp rise in this indicator stands in stark contrast to the prepandemic trend, when the iMMR was falling steadily since 2010.

The findings are much worse than those reported by Stats SA in mid-April, which surprised local researchers with data that bucked the international trend of worsening outcomes for pregnant women and their newborn babies during the pandemic.

Stats SA reported on April 14 that SA’s iMMR had fallen from 106 deaths per 100,000 live births in 2019 to 88 per 100,000 in 2020.

Soma-Pillay said it was likely that Stats SA underestimated maternal deaths by incorrectly classifying Covid-19 deaths among pregnant women as incidental deaths, and therefore excluded them.

The SA Health Review highlighted a marked reduction in maternal health services, with the number of terminations of pregnancy falling 17% from 124,446 in 2019/2020 to 103,350 in 2020/2021.

Over the same period, the number of prescriptions written for contraceptives dropped 5%, and the proportion of women who booked their first antenatal clinic visit before 20 weeks fell from 69.7% to 67.9%.