The COVID-19 epidemic has had a severe effect on maternal and perinatal mortality in South Africa, according to the SA Health Review of 2021, released last week. Maternal deaths increased by 40%, stillbirths by10% in stillbirths and perinatal mortality by 8%.

There was a 28% increase in the institutional maternal mortality ratio in all provinces during the second wave compared with the first wave, except in the Western Cape which had a decrease of 1%. The year-on-year analysis found that prescriptions for contraceptives declined by, as did the number of terminations of pregnancy, by 17%.

The authors note that there have been two “markedly different” regional effects of COVID-19 on maternal care: the rural provinces experienced increased pressure on their services due to pregnant women migrating from metropolitan areas back to their homes, increasing the burden on already under-resourced facilities; and metropolitan areas were inundated with severe COVID-19-specific conditions, leading to an increased burden in these areas and an inability to manage routine emergencies

The deaths statistics undo the hard-won gains in South African maternal health in the decade years before COVID-19. Globally, the pandemic dealt pregnant women a double blow: pregnancy increases the risk of severe disease, yet access to health services was severely disrupted.

The researchers – Robert Pattinson of the SA Medical Research Council and the University of Pretoria, Sue Fawcus of the University of Cape Town, Stefan Gebhardt of the University of Stellenbosch and Tygerberg Hospital, Priya Soma-Pillay of the University of Pretoria, Ronelle Niit of the Health Information Systems Programme, and Jack Moodley of the University of KwaZulu-Natal – 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 (like car accidents).

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