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.