Resilience in the time of crisis: A review of the maternal, perinatal and reproductive health effects of COVID-19 in South Africa
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...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
South African Medical Association
2024-05-01
|
| Series: | South African Medical Journal |
| Subjects: | |
| Online Access: | https://samajournals.co.za/index.php/samj/article/view/1757 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1823860587401052160 |
|---|---|
| author | S Fawcus S Gebhardt R Niit R Pattinson |
| author_facet | S Fawcus S Gebhardt R Niit R Pattinson |
| author_sort | S Fawcus |
| collection | DOAJ |
| description |
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.
|
| format | Article |
| id | doaj-art-8ed17f2447c142ce805e03ed6d434495 |
| institution | Kabale University |
| issn | 0256-9574 2078-5135 |
| language | English |
| publishDate | 2024-05-01 |
| publisher | South African Medical Association |
| record_format | Article |
| series | South African Medical Journal |
| spelling | doaj-art-8ed17f2447c142ce805e03ed6d4344952025-02-10T12:26:10ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352024-05-01114510.7196/SAMJ.2024.v114i5.1757Resilience in the time of crisis: A review of the maternal, perinatal and reproductive health effects of COVID-19 in South AfricaS Fawcus0https://orcid.org/0000-0002-1818-7171S Gebhardt1R Niit2R Pattinson3Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, South Africa Department Obstetrics and Gynaecology, University of Stellenbosch and Tygerberg Hospital, Cape Town, South AfricaHealth Information Systems/Monitoring and Evaluation, Pretoria, and Western Cape, South AfricaSAMRC/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 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. https://samajournals.co.za/index.php/samj/article/view/1757Covid 19, Maternal mortality, Perinatal Mortality, Causes of death, Service utilisation |
| spellingShingle | S Fawcus S Gebhardt R Niit R Pattinson Resilience in the time of crisis: A review of the maternal, perinatal and reproductive health effects of COVID-19 in South Africa South African Medical Journal Covid 19, Maternal mortality, Perinatal Mortality, Causes of death, Service utilisation |
| title | Resilience in the time of crisis: A review of the maternal, perinatal and reproductive health effects of COVID-19 in South Africa |
| title_full | Resilience in the time of crisis: A review of the maternal, perinatal and reproductive health effects of COVID-19 in South Africa |
| title_fullStr | Resilience in the time of crisis: A review of the maternal, perinatal and reproductive health effects of COVID-19 in South Africa |
| title_full_unstemmed | Resilience in the time of crisis: A review of the maternal, perinatal and reproductive health effects of COVID-19 in South Africa |
| title_short | Resilience in the time of crisis: A review of the maternal, perinatal and reproductive health effects of COVID-19 in South Africa |
| title_sort | resilience in the time of crisis a review of the maternal perinatal and reproductive health effects of covid 19 in south africa |
| topic | Covid 19, Maternal mortality, Perinatal Mortality, Causes of death, Service utilisation |
| url | https://samajournals.co.za/index.php/samj/article/view/1757 |
| work_keys_str_mv | AT sfawcus resilienceinthetimeofcrisisareviewofthematernalperinatalandreproductivehealtheffectsofcovid19insouthafrica AT sgebhardt resilienceinthetimeofcrisisareviewofthematernalperinatalandreproductivehealtheffectsofcovid19insouthafrica AT rniit resilienceinthetimeofcrisisareviewofthematernalperinatalandreproductivehealtheffectsofcovid19insouthafrica AT rpattinson resilienceinthetimeofcrisisareviewofthematernalperinatalandreproductivehealtheffectsofcovid19insouthafrica |