Maternal mortality in Colombia during the COVID-19 pandemic: time series and social inequities

Abstract

ObjectiveThe impact of the COVID-19 pandemic goes beyond morbidity and mortality from that disease. Increases in maternal mortality have also been described but have not been extensively studied to date. This study aimed to examine changes in maternal mortality and identify correlates and predictors of excess maternal mortality in Colombia during the pandemic.SettingAnalysis of data from the national epidemiological surveillance databases of Colombia (Sivigila).ParticipantsDeaths among 6342 Colombian pregnant women who experienced complications associated with pregnancy, childbirth or the perperium during 2008–2020 were included in this study. For inequalities analysis, a subsample of 1055 women from this group who died in 2019 or 2020 years were analysed.MethodsWe collected data from the national surveillance system (Sivigila) on maternal mortality. Analysis was carried out in two stages, starting with a time series modelling using the Box-Jenkins approach. Data from Sivigila for 2008–2019 were used to establish a baseline of expected mortality levels. Both simple and complex inequality metrics, with the maternal mortality ratios (MMRs), were then calculated using the Multidimensional Poverty Index as a socioeconomic proxy.ResultsMaternal deaths in 2020 were 12.6% (95% CI −21.4% to 95.7%) higher than expected. These excess deaths were statistically significant in elevation for the months of July (97.4%, 95% CI 35.1% to 250.0%) and August (87.8%, 95% CI 30.5% to 220.8%). The MMR was nearly three times higher in the poorest municipalities compared with the most affluent communities in 2020.ConclusionsThe COVID-19 pandemic had considerable impact on maternal health, not only by leading to increased deaths, but also by increasing social health inequity. Barriers to access and usage of essential health services are a challenge to achieving health-related Sustainable Development Goals.

Impact of the COVID-19 Pandemic on Births, Vaginal Deliveries, Cesarian Sections, and Maternal Mortality in a Brazilian Metropolitan Area: A Time-Series Cohort Study

“…This finding shows the heightened vulnerability of women with lower income and disadvantaged living conditions, emphasizing the exacerbation of healthcare access inequities during the COVID-19 pandemic. 58 Our study did not show difference in the number of births in the public maternities of FD comparing the pre-and post-COVID-19 pandemic period that was also observed in a study performed in Ethiopia. 55 However, it is important to analyze this finding within the context of how the pandemic has impacted healthcare services in different locations.…”

Factors associated with maternal mortality in Kazakhstan: a pre- and during-pandemic comparison

“…A study from Kazakhstan reported that higher age associated with greater mortality risk in this period, and from 2019 to 2021 in Kazakhstan, there was a rise in mortality rates among women aged 35–39 from 0.48 to 4.37 per 100,000 individuals ( 48 , 49 ). Overall, even before the pandemic, obesity and high school non-completion were identified as important contributors to maternal mortality, while access to healthcare services and resources, family factors, such as revenue and education, and ecological determinants as poverty, gender inequality, human development also played a role ( 3 , 6 , 50 ).…”

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