A setback for Sustainable Development Goal 3.1: Documenting the coronavirus disease 2019 pandemic’s impact on maternal mortality through a National Confidential Enquiry in South Africa

Key findings from this study

This research indicates that:

• The national institutional Maternal Mortality Ratio surged 42% during the COVID-19 pandemic, reversing pre-pandemic improvements and pushing South Africa off track from SDG 3.1 targets.
• Recovery to 2019 baseline levels remained incomplete as of 2022, indicating systemic vulnerabilities in maternal healthcare delivery.
• Three provinces consistently exhibited exceptionally high and volatile institutional Maternal Mortality Ratios while only two sustained downward trends, highlighting entrenched provincial inequities.

Overview

South Africa's Confidential Enquiry into Maternal Deaths analysed institutional Maternal Mortality Ratio trends between 2017 and 2022 to assess progress toward Sustainable Development Goal 3.1. The pandemic reversed prior improvements in maternal mortality, while persistent provincial inequalities undermine the trajectory toward the SDG target.

Methods and approach

Longitudinal trend analysis examined secondary data from CEMD reports spanning 2017–2022. The analysis tracked national and provincial institutional iMMR trends using comparative analysis to quantify changes and identify disparity patterns.

Results

Pre-pandemic improvements were abruptly reversed by a 42% surge in the national iMMR during the pandemic period. Although 2022 showed decreased rates compared to peak pandemic levels, values remained above 2019 baseline levels, indicating incomplete recovery. Inter-provincial disparities were substantial: only two provinces sustained downward trends, most showed no clear improvement, and three exhibited consistently high and volatile iMMRs.

Implications

South Africa's health system lacks resilience to withstand external shocks, as evidenced by pandemic-induced reversals of mortality improvements. The fragility of previous gains demonstrates that short-term reductions without systemic strengthening prove unsustainable. Addressing maternal mortality reduction requires simultaneous action on two fronts: establishing a more robust health infrastructure and implementing equity-focused interventions in underperforming provinces. Without targeted regional approaches, national averages mask persistent failures in specific jurisdictions where maternal healthcare remains inaccessible or ineffective.

Scope and limitations

This summary is based on the study abstract and available metadata. It does not include a full analysis of the complete paper, supplementary materials, or underlying datasets unless explicitly stated. Findings should be interpreted in the context of the original publication.