AFJOG

Maternal death is one of humanity’s greatest tragedies and a violation of women’s right to life. It reflects the enduring disparities and challenges to access quality healthcare, including society’s responsibility to uphold a woman’s right to life and protection of her dignity. The right to life is a constitutional right and women are no exception. From a quality-of-care perspective, maternal deaths reflect systemic failures within healthcare systems driven in part by resource and workforce deficiency gaps in clinical decision-making. In South Africa, a system of National Confidential Enquiries into Maternal Deaths (NCCEMD) exists to review maternal deaths. This team consists of highly committed healthcare professionals who dedicated their time to the confidential assessments of individual maternal deaths in all nine provinces in South Africa. This confidential inquiry identifies challenges in the healthcare system, and makes recommendations for improvement. These recommendations are produced in the form of annual and triennial reports which highlight shortcomings in the health care system, avoidable factors in individual clinical care, and whether death could have been prevented. The NCCEMD works as a ministerial team, with support from the honourable Minister of health, the Honourable Dr A. Motsoaledi and previously, the Honourable Dr J. Phaahla, the National Department of Health (NDOH) and the Maternal, Child, and Women's Health (WCWH)teams. It's quite a mammoth task to bring such triennial and annual reports to fruition, as it involves tremendous effort, energy and meticulous attention to detail. Professor S Fawcus (editor), Professor L Chauke (co-editor) of the Saving Mothers’ Reports and Dr B. Mamabolo (SAMRC- UP) need special mention and South Africa's gratitude for these thoughtful documents and contributions that they have made to decrease maternal and newborn deaths in South Africa. South Africa recently celebrated the success of implementing the recommendations from the latest triennial report (Saving Mothers’ Reports 2017–2019), i.e., for the first time since the initial report in 1998, the institutional maternal mortality ratio (iMMR) had dropped to less than 100 per 100,000 live births. This was certainly an achievement for South Africa, being one of the few countries in the world that has an assessment of individual deaths and implements the recommendations. In addition, the unexpected COVID-19 pandemic both directly and indirectly effects on our health system, and its aftermath is still evident The key findings for the 2020-2022 Saving mothers’ report were that: • The institutional maternal mortality rate (iMMR) increased by 30% in 2020 and 47% in 2021, (compared to 2019) during the Covid pandemic but decreased to pre-pandemic levels in 2022, and this trend was seen in all provinces. • Covid pneumonia /NPRI deaths were the major contributors to the steep increase in 2020 & 2021 • Deaths from Obstetric Haemorrhage increased in 2020 and 2021, reflecting the collateral impact of the COVID-19 pandemic on the functioning of the health system. • Hypertensive deaths and deaths from medical and surgical disorders were the third and fourth most common causes, followed by early pregnancy complications. • Administrative avoidable factors increased in 2020 and 2021 but not patient or healthcare worker related factors • The NCCEMD process was impacted by the COVID-19 pandemic due to increased workload and ill healthcare workers • The COVID-19 pandemic set back progress towards achieving the Sustainable Development Goals (SDG) of reducing maternal mortality rates to 70 per 100 000 live births by 2030, but now we’re back on track, and hopefully great lessons are learned for the future (please see the below figure and table). Comparison of iMMR per year starting from 2017, pre- pandemic, pandemic, and post-pandemic (2020 and 2022) for primary obstetric cause. iMMR for Primary Obstetric Cause per year 2020-2022 (uncorrected) 2020 2021 2022 2020-2022 Hypertensive disorders of pregnancy 17.87 18.51 17.15 17.9 Obstetric haemorrhage 19.32 23.33 16.73 19.8 Ectopic pregnancy 3.48 3.25 3.51 3.4 Miscarriage 4.73 5.32 6.51 5.5 Pregnancy-related sepsis 6.09 6.9 5.78 6.2 Anaesthetic complications 2.03 1.69 4.03 2.6 Embolism 3.19 4.23 4.13 3.8 Acute collapse - cause unknown 1.45 3.54 2.17 2.4 Maternal Mortality in South Africa -The Confidential Inquiries 2020-2022 S N Cebekhulu Dr George Mukhari Academic Hospital, Department of Obstetrics and Gynaecology, Sefako Makgatho Health Science University, Deputy Chairperson and Chairperson National Committee on Confidential Enquiries into Maternal Deaths, Gauteng, South Africa EDITORIAL African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 1 | 2025 | 01