Pregnant women in SA died in 2021 at a rate not seen for almost a decade, according to a new government report that lays bare the devastating effects of the coronavirus pandemic.
Covid-19 presented pregnant women with a dual threat, as access to health services was disrupted by the government’s response to the pandemic, even as the virus increased their risk of pregnancy-related complications.
The “Saving Mothers Report 2020-22” shows how the pandemic reversed years of slow but steady improvement in SA’s institutional maternal mortality rate (iMMR), throwing the country off its trajectory towards the sustainable development goal of reducing the iMMR to below 70 per 100,000 live births.
The iMMR reflects women giving birth in health facilities and is routinely monitored worldwide to gauge the strength of a health system.
The iMMR rose from 98.8 per 100,000 live births in 2019 to 119.2 per 100,000 in 2020 and then soared to 148.4 in 2021, before falling in 2022 to 109.7.
Maternal deaths are defined as deaths during pregnancy, childbirth or in the 42 days that follow. SA’s first coronavirus case was identified on March 5 2020, but vaccines only became widely available in the second half of 2021.
The total number of maternal deaths rose from 1,022 in 2019 to 1,234 in 2020 and then leapt to 1,507 in 2021, a 47% increase from the prepandemic level. The number of maternal deaths dropped to 1,062 in 2022.
Nonpregnancy-related infections were the leading cause of maternal death, almost half of which were due to Covid-19, which accounted for 505 deaths over the three-year period.
Pregnant women using both public and private healthcare facilities were at increased risk during the pandemic. In 2021 there were 128 maternal deaths in private hospitals, a 60% increase from the 80 recorded the year before. In 2022, the number of maternal deaths in private hospitals dropped to 36.
The surge in maternal deaths in private hospitals highlights the risk Covid-19 posed to pregnant women regardless of their socioeconomic status, said the report’s editor, Sue Fawcett.
The second most common cause of death among pregnant women was obstetric haemorrhage, or excessive bleeding, which accounted for 599 deaths between 2020 and 2022.
“Deaths from obstetric haemorrhage increased in 2020 and 2021, reflecting the collateral impact of Covid-19 on the functioning of our health system,” said Sylvia Cebekhulu, chair of the National Committee on Confidential Enquiries into Maternal Deaths.
As more than 85% of maternal deaths due to obstetric haemorrhage are preventable, one of the report’s strongest recommendations is that the department of health implement recently developed measures that improve the ability of doctors and nurses to gauge how much blood a woman is losing in childbirth and provide a bundle of potentially life-saving treatments.
Research published in 2023 showed that measuring blood loss with a simple bed drape that allows a healthcare worker to see at a glance if a woman is bleeding excessively, combined with a set of treatments that are provided together instead of sequentially, cut deaths 20%. This package, dubbed E-MOTIVE, was tested in 200,000 women in four countries, including SA, and is a potential game changer, said Fawcett.
The department of health is planning a feasibility study to test whether E-MOTIVE can be implemented in a nonresearch environment, with a view to progressively rolling it out across SA, said its chief director for women’s, maternal and peproductive health, Manala Makua.
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