{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T20:00:38Z","timestamp":1780430438638,"version":"3.54.1"},"reference-count":0,"publisher":"South African Medical Association NPC","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["S Afr Med J"],"abstract":"<jats:p>Background. During the COVID-19 pandemic, there was a notable increase in maternal deaths across South Africa (SA). Pre pandemic, the Western Cape Province, SA, had made significant strides towards reducing maternal mortality, including HIV-related deaths. However, this progress was reversed in the pandemic period despite a relative protection of maternity services. The direct biological impact of SARS- CoV-2 may not be the sole reason for the increase in mortality.\nObjective. To evaluate the relative change in the maternal death rate (MDR) for non-SARS-CoV-2-related deaths during the pandemic v. pre pandemic in 2019.\nMethods. We conducted a retrospective cohort study including all pregnant women with a pregnancy outcome enumerated in the Provincial Health Data Centre in the Metro West region of Cape Town from 1 January 2019 to 31 January 2022. Cause of in-facility maternal death and relationship to SARS-CoV-2 infection was determined by folder review. We used interrupted time series (ITS) analysis to assess the impact of the pandemic period on non-SARS-CoV-2 causes of maternal mortality.\nResults. Over 98 000 women were included, with 68 deaths reviewed. The ITS model demonstrated no statistically significant change in the MDR for non-SARS-CoV-2-related deaths during the pandemic, with confidence intervals (CIs) that crossed the null for both a step change at the start of the pandemic (3.12\/10 000 pregnancy outcomes; 95% CI \u20131.66 - 7.90) and a subsequent attenuation in the pre-pandemic downward gradient in MDR (slope change 0.47\/10 000 pregnancy outcomes per month (95% CI \u20130.02 - 0.96). Folder review of deaths demonstrated an increase in opportunistic infections as a cause of death relative to the pre-pandemic period, mainly in women with HIV.\nConclusion. Maternal healthcare services were largely protected from service disruptions during the COVID-19 pandemic. However, the increase in HIV-related opportunistic infections suggests that optimising maternal health requires an all-encompassing, functional healthcare ecosystem that can robustly maintain services for all health conditions.<\/jats:p>","DOI":"10.7196\/samj.2026.v116i5.3856","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T19:01:13Z","timestamp":1780426873000},"page":"e3856","source":"Crossref","is-referenced-by-count":0,"title":["The impact of the COVID-19 pandemic on maternal mortality in a South African metropole (2020 - 2021): A retrospective cohort study"],"prefix":"10.7196","author":[{"given":"M","family":"Hunter","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Hannan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Boulle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Matjila","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Ismail","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Euvrard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M-A","family":"Davies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E","family":"Kalk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4425","published-online":{"date-parts":[[2026,6,2]]},"container-title":["South African Medical Journal"],"original-title":[],"link":[{"URL":"https:\/\/samajournals.co.za\/index.php\/samj\/article\/download\/3856\/1867","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/samajournals.co.za\/index.php\/samj\/article\/download\/3856\/1867","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T19:01:15Z","timestamp":1780426875000},"score":1,"resource":{"primary":{"URL":"https:\/\/samajournals.co.za\/index.php\/samj\/article\/view\/3856"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,2]]},"references-count":0,"URL":"https:\/\/doi.org\/10.7196\/samj.2026.v116i5.3856","relation":{},"ISSN":["2078-5135","0256-9574"],"issn-type":[{"value":"2078-5135","type":"electronic"},{"value":"0256-9574","type":"print"}],"subject":[],"published":{"date-parts":[[2026,6,2]]}}}