South Africa’s maternal mortality improvement stalled during the pandemic

What the study found: South Africa’s earlier progress in reducing maternal mortality was sharply reversed during the COVID-19 pandemic. The national institutional Maternal Mortality Ratio (iMMR) rose by 42% during the pandemic, and by 2022 it had improved but was still above the 2019 level.

Why the authors say this matters: The authors say South Africa is not yet on track to meet Sustainable Development Goal 3.1, which is the global target for reducing maternal deaths. They conclude that the pandemic exposed and worsened health-system weaknesses, while deep provincial inequalities remain.

What the researchers tested: The researchers carried out a longitudinal trend analysis using secondary data from South Africa’s Confidential Enquiry into Maternal Deaths reports from 2017 to 2022. They examined national and provincial institutional Maternal Mortality Ratio trends and compared changes to identify disparities.

What worked and what didn't: Before the pandemic, maternal mortality was improving, but that trend was abruptly reversed during COVID-19. A decline was seen in 2022, but the national rate still had not returned to the 2019 baseline. Only two provinces sustained downward trends, most showed no clear improvement, and three provinces had consistently very high and volatile iMMRs.

What to keep in mind: The abstract does not describe limitations beyond the use of secondary report data and the focus on 2017–2022. The findings are specific to South Africa and to the institutional maternal mortality ratio reported through the confidential enquiry system.

Key points

• South Africa’s national institutional maternal mortality ratio rose by 42% during the COVID-19 pandemic.
• A decline was seen in 2022, but the rate remained above the 2019 baseline.
• Only two provinces sustained a downward trend in maternal mortality.
• Three provinces had consistently high and volatile institutional maternal mortality ratios.
• The authors say South Africa is not yet on track for Sustainable Development Goal 3.1.