Resilience in the time of crisis: A review of the maternal, perinatal and reproductive health effects of COVID-19 in South Africa

Authors

  • S Fawcus Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, South Africa https://orcid.org/0000-0002-1818-7171
  • S Gebhardt Department Obstetrics and Gynaecology, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa
  • R Niit Health Information Systems/Monitoring and Evaluation, Pretoria, and Western Cape, South Africa
  • R Pattinson SAMRC/University of Pretoria Maternal and Infant Health Care Strategies Unit and Research Centre for Maternal, Fetal, Newborn and Child Health, University of Pretoria, South Africa

DOI:

https://doi.org/10.7196/SAMJ.2024.v114i5.1757

Keywords:

Covid 19, Maternal mortality, Perinatal Mortality, Causes of death, Service utilisation

Abstract

Background. The COVID‐19 pandemic had a profound effect on the health sector globally and in South Africa (SA).

Objective. To review the effects of COVID‐19 on maternal, perinatal and reproductive health outcomes and service utilisation in SA.

Methods. Three routine national data collection systems were sourced: the District Health Information System, the Saving Mothers reports of the National Committee on Confidential Enquiry into Maternal Deaths and the Saving Babies reports from the National Perinatal Morbidity and Mortality Committee using data from the Perinatal Problem Identification Program.

Results. There were 35% and 8% increases in maternal and stillbirth mortality rates, respectively, in 2020 and 2021, which correlated with the COVID‐19 waves. However, in 2022, rates returned to pre‐COVID levels. Antenatal visits and facility births showed little change, but there was a shift to more rural provinces. The use of oral and injectable contraceptives and termination of pregnancy services decreased markedly in 2020 and 2021, with a sustained shift to long‐acting reversible contraceptives. The increase in maternal deaths was predominantly due to COVID‐19 respiratory complications, but also an increase in obstetric haemorrhage. Stillbirths increased significantly (10%) for birthweights between 2 000 g and 2 499 g, categorised mostly as unexplained stillbirths or preterm labour, but no increase in neonatal deaths was observed. Administrative avoidable factors increased by 24% in the 2020 ‐ 2022 triennium, but there was no increase in patient/community level or healthcare provider‐related avoidable factors during the pandemic years.

Conclusion. COVID‐19 caused a marked increase in maternal death and stillbirth rates in 2020 and 2021 due to both direct effects of the virus and indirect effects on functioning of the health system. The continued, although modified, health‐seeking behaviour of women and the rapid return to pre‐COVID‐19 mortality rates demonstrates enormous resilience in women and the health system.

Author Biographies

  • S Fawcus, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, South Africa

    Senior Scholar Department Obstetrics and Gynaecology
    University of Cape Town
    Obstetrics and Gynaecology
    SOUTH AFRICA

  • S Gebhardt, Department Obstetrics and Gynaecology, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa

    Professor and Chief Specialist, University Stellenbosch and Tygerberg Department Obstetrics and Gynaecology

  • R Niit, Health Information Systems/Monitoring and Evaluation, Pretoria, and Western Cape, South Africa

    Project Manager, Health Information Systems/Monitoring and evaluation, Pretoria and Western Cape, South Africa

  • R Pattinson, SAMRC/University of Pretoria Maternal and Infant Health Care Strategies Unit and Research Centre for Maternal, Fetal, Newborn and Child Health, University of Pretoria, South Africa

    Emeritus Professor: SAMRC/UP Maternal and Infant Health Care Strategies Unit and Research Centre, University Pretoria

References

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Published

2024-05-09

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How to Cite

1.
Fawcus S, Gebhardt S, Niit R, Pattinson R. Resilience in the time of crisis: A review of the maternal, perinatal and reproductive health effects of COVID-19 in South Africa. S Afr Med J [Internet]. 2024 May 9 [cited 2024 May 19];114(5):e1757. Available from: https://samajournals.co.za/index.php/samj/article/view/1757

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