Abstract:
South Africa experienced two waves of COVID-19 infection
in the financial year 2020/21. This study examines the impact
of these waves on maternal and perinatal mortality and their
effect on the use of and access to maternal and reproductive
health services.
Data from the District Health Information System on maternal
and perinatal deaths, births, antenatal visits, and use of
contraceptive termination of pregnancy services were used,
and the 2020/21 and 2019/20 financial years were compared
in order to formulate national and provincial perspectives.
Data on visits for initiating antenatal care, births, contraceptive
prescriptions and termination-of-pregnancy services were
used to assess utilisation of maternal and reproductive health
services respectively; and the number and rates of maternal and
perinatal deaths were examined to assess impact. A second
descriptive analysis of pregnant women who had delivered after
having contracted COVID-19 was performed using a separate
database set up by the National Department of Health/South
African Medical Research Council/University of Pretoria (NDoH/
SAMRC/UP), specifically to monitor the effects of COVID-19).
The data suggest that there was a marked increase (of 40%)
in maternal deaths (p<0.00001), 10% in stillbirths (p<0.00001),
and 3% in (p=0.31) neonatal deaths when compared with the
same period in 2019/20. There was a mean 28% increase in the
institutional maternal mortality ratio in all provinces during the
second wave compared with the first wave (p<0.0001), except
in the Western Cape which had a decrease of 1%. Data from the
National Institute for Communicable Diseases showed that the
case fatality rate for pregnant women with COVID-19 was high
(4.5%), as was the perinatal mortality rate (70.6 per 1 000 births),
while the institutional maternal mortality ratio for South Africa
was 16.94/100 000 live births.
An increase of 3.6% in in-facility births in 2020/21 compared
with 2019/20 was observed, with increased movement of
pregnant women to the more rural provinces and districts
for delivery. Antenatal care services were maintained
overall, but use of reproductive health services declined
(contraceptive prescriptions by 5%, and termination of
pregnancy by 17% overall).
The effect of the COVID-19 epidemic on pregnant women
and its collateral damage is severe. Strengthening the health
system to maintain essential services during a pandemic and
vaccination of healthcare workers and pregnant women are
key to reducing maternal and perinatal mortality.
