Health system stress: Assessing the impact of the COVID-19 pandemic on obstetric haemorrhage-related mortality in South Africa using confidential enquiry into maternal deaths data

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic placed unprecedented strain on healthcare systems worldwide, potentially exacerbating existing vulnerabilities in maternal healthcare. This study examines the pandemic's impact on obstetric haemorrhage-related mortality in South Africa using the data from the Confidential Enquiry into Maternal Deaths (CEMD). METHODS: We conducted a retrospective analysis of maternal mortality data from 2017-2023, focusing on obstetric haemorrhage mortality trends before, during and after the COVID-19 pandemic. Data were extracted from national confidential enquiries, including institutional maternal mortality ratios (iMMR) and absolute death numbers. RESULTS: The analysis revealed a significant increase in obstetric haemorrhage mortality during the peak pandemic years (2020-2021), with deaths rising from 179 in 2019 to 237 in 2021, and iMMR increasing from 18.1 to 23.3 per 100 000 live births. This was followed by a substantial decline in subsequent years (2022-2023). The findings suggest that initial pandemic disruptions severely impacted maternity care services, while subsequent recovery reflects adaptive strategies and resource reallocation. CONCLUSION: The COVID-19 pandemic exposed critical vulnerabilities in South Africa's ability to maintain essential maternity services during health system shocks.Contribution: The confidential enquiry process provides invaluable insights for strengthening health system resilience and preparing for future emergencies.