Brazzaville, September 2021 — The COVID-19 pandemic has taken a heavy toll on women's health across Africa, with a World Health Organization analysis revealing that maternal deaths in health facilities rose by an average of 16% across surveyed African countries during the early months of the pandemic — and the increase persisted into 2021, threatening years of hard-won progress in reducing maternal mortality across the continent.
The WHO survey of 11 African countries found that maternal deaths in health facilities increased by an average of 16% between February and May 2020 compared to the same period in 2019. The figure remained elevated at an 11% increase in 2021, indicating that the pandemic's impact on maternal health was not a temporary disruption but a sustained crisis.
Two Pathways of Harm
The WHO and public health researchers identified two primary mechanisms through which the pandemic increased maternal mortality:
Indirect obstetric deaths were driven by the interaction between SARS-CoV-2 infection and pregnancy. Pregnant women with COVID-19 faced higher risks of severe complications, admission to intensive care, and death compared to non-pregnant women of reproductive age. The physiological changes of pregnancy — including decreased lung capacity, increased heart rate, and altered immune function — made pregnant women particularly vulnerable to respiratory infections.
Direct obstetric deaths resulted from disruptions to essential maternal healthcare services. The pandemic disrupted antenatal care, skilled birth attendance, emergency obstetric services, and postnatal care through multiple pathways:
- Fear and restrictions: Fear of contracting COVID-19 at health facilities, combined with lockdowns and movement restrictions, deterred women from seeking routine antenatal care and skilled birth attendance.
- Systemic strain: Healthcare systems, already under-resourced in many African countries, were overwhelmed by the pandemic response, reducing the quality and availability of maternal care. Health workers were redeployed to COVID-19 response, and essential supplies were diverted.
- Transportation barriers: Lockdowns and economic hardship made it difficult for women to travel to health facilities, particularly in rural areas where distances are already significant.
Regional Evidence
Research from individual countries provided more granular evidence of the pandemic's impact. In South Africa, which maintained some of the most detailed maternal health data on the continent, studies indicated a 40% increase in maternal deaths during the 2020/21 financial year compared to the 2019/20 period.
Facility-based births were observed to decrease in 45% of surveyed countries between November and December 2021 compared to pre-pandemic levels, suggesting that women were increasingly delivering outside health facilities — often without skilled attendants and emergency backup.
Beyond Mortality: Broader Impacts on Women's Health
The impact of the pandemic extended beyond maternal mortality. Increased poverty and disruptions to reproductive health services led to higher rates of unintended pregnancies, including a marked rise in teenage pregnancies in countries such as South Africa and Kenya. School closures, which kept millions of girls at home, contributed to this trend, as did reduced access to family planning services.
The WHO Regional Office for Africa documented significant interruptions to sexual, reproductive, maternal, newborn, child, and adolescent health services across the region. Many countries reported that routine immunization, antenatal care visits, and family planning consultations were disrupted at critical moments, with effects that would ripple through health outcomes for years to come.
The Pre-Pandemic Baseline
The maternal health setbacks were particularly devastating because they came after years of steady, if uneven, progress. Between 2000 and 2017, the global maternal mortality ratio fell by approximately 38%, according to WHO data. Sub-Saharan Africa, while still bearing the highest burden of maternal deaths globally, had been making incremental gains through expanded access to skilled birth attendants, improved emergency obstetric care, and stronger health systems.
The pandemic threatened to reverse these gains. WHO noted that the facility-based figures likely underestimated the true impact, as many maternal deaths in the African region occur at home rather than in health facilities — a pattern that may have intensified during the pandemic as women avoided hospitals.
The Path to Recovery
The WHO Regional Office for Africa published guidance aimed at mitigating the impact of COVID-19 on reproductive, maternal, newborn, and child health services, urging countries to:
- Maintain essential maternal and reproductive health services even during pandemic surges
- Implement infection prevention and control measures in maternity wards to build confidence
- Use telehealth and community-based approaches to maintain antenatal care contact
- Ensure that pandemic response funding does not crowd out essential health services
- Strengthen health systems to be resilient to future shocks
The maternal health crisis during COVID-19 underscored a fundamental truth: health systems cannot afford to treat pandemic response and essential services as competing priorities. The women who died during childbirth because they could not or would not access a health facility during the pandemic are a stark reminder that every disruption to essential care carries a human cost — one that is often invisible in pandemic statistics but devastatingly real to the families left behind.
Sources
- World Health Organization Regional Office for Africa, "COVID-19 takes heavy toll on women's health"
- WHO, "Mitigating the impact of COVID-19 on Reproductive, Maternal, Newborn and Child Health Services," March 2022
- WHO, Maternal Mortality Fact Sheet
- University of Pretoria, Research on maternal mortality in South Africa during COVID-19
- Think Global Health, "Falling Through the Cracks: COVID-19 and the Rise of Maternal Deaths in Africa"
FIRAT Editorial Board
Institutional Research Desk · Foresight Institute of Research and Translation
The collective editorial and research translation board of FIRAT, synthesising peer-reviewed evidence, policy briefs, and division milestones across our seven foundational research pillars.
