ArticleSouth African family practice : official journal of the South African Academy of Family Practice/Primary Care2026
Health system stress: Assessing the impact of the COVID-19 pandemic on obstetric haemorrhage-related mortality in South Africa using confidential enquiry into maternal deaths data.
Article in South African family practice : official journal of the South African Academy of Family Practice/Primary Care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe coronavirus disease 2019 (COVID-19) pandemic placed unprecedented strain on healthcare systems worldwide, potentially exacerbating existing vulnerabilities in maternal healthcare. This study examines the pandemic's impact on obstetric haemorrhage-related mortality in South Africa using the data from the Confidential Enquiry into Maternal Deaths (CEMD).
methodsWe conducted a retrospective analysis of maternal mortality data from 2017-2023, focusing on obstetric haemorrhage mortality trends before, during and after the COVID-19 pandemic. Data were extracted from national confidential enquiries, including institutional maternal mortality ratios (iMMR) and absolute death numbers.
resultsThe analysis revealed a significant increase in obstetric haemorrhage mortality during the peak pandemic years (2020-2021), with deaths rising from 179 in 2019 to 237 in 2021, and iMMR increasing from 18.1 to 23.3 per 100 000 live births. This was followed by a substantial decline in subsequent years (2022-2023). The findings suggest that initial pandemic disruptions severely impacted maternity care services, while subsequent recovery reflects adaptive strategies and resource reallocation.
conclusionThe COVID-19 pandemic exposed critical vulnerabilities in South Africa's ability to maintain essential maternity services during health system shocks.Contribution: The confidential enquiry process provides invaluable insights for strengthening health system resilience and preparing for future emergencies.
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