Too few mothers saved: South Africa faces slow progress on maternal deaths

South Africa is not reducing maternal deaths fast enough to meet its 2030 target, with a specialist warning that the rate is declining by only about 1.5% a year.

Dr Olivia Barigye, a foetal maternal medicine specialist, said the latest National Committee for Confidential Enquiry into Maternal Deaths annual report shows a slight increase in maternal mortality between 2022 and 2023 after deaths declined following the peak during the Covid-19 pandemic.

According to the health department’s “Saving Mothers” report, South Africa recorded 987 maternal deaths in 2023, with a corrected maternal mortality ratio of 111.7 deaths per 100,000 live births, up from 109.6 in 2022 and from 98.8 in 2019 before the onset of Covid-19.

Speaking at the Women’s Health Matters Conference in Johannesburg on Thursday, Barigye said the country needs to speed up the decline to reach the target maternal mortality ratio of 70 deaths per 100,000 live births by 2030.

“The rate of decline in maternal mortality is too slow,” she said.

She also highlighted embolism, or blood clots that travel to the lungs, as an important cause of maternal deaths.

One of the major problems is that some women only start antenatal care late in their pregnancies, missing the opportunity for health-care workers to identify risks and put the right care plan in place—  Dr Olivia Barigye

Early identification of high-risk pregnancies is critical to preventing deaths.

“One of the major problems is that some women only start antenatal care late in their pregnancies, missing the opportunity for health-care workers to identify risks and put the right care plan in place

Maternal health-care should ideally start even before pregnancy, with women encouraged to manage conditions such as diabetes, obesity and heart problems before conceiving.

“Once pregnant, women should attend antenatal appointments early and continue seeing specialists if they have existing medical conditions.”

Barigye said the health system also needs to improve the support given to junior doctors dealing with serious emergencies. She highlighted difficult caesarean sections as one area where junior doctors need experienced senior support. Better ultrasound services are also needed to identify serious pregnancy complications early.

“Better ultrasound services can help identify an abnormally attached placenta, which can cause severe bleeding during delivery and require careful planning before birth.”

More resources, skills training, emergency drills and support for health-care workers are needed to reduce maternal deaths, she added.

I encourage pregnant women to attend antenatal care from early in their pregnancy, learn the warning signs of complications and have a birth partner where possible—  Ayanda Ngidi, midwife specialist

Midwife specialist Ayanda Ngidi said misinformation about the role of midwives is another problem. Many women do not realise that midwives are specially trained to:

All pregnant women that are low-risk in their pregnancies should see a midwife, Ngidi said.

Ngidi said women need to receive this information early so they could make informed decisions about where and how they would give birth.

She warned that women who do not receive antenatal care may arrive at a hospital or clinic in labour with complications that could have been detected earlier. “If you’ve missed out on that, at the end when you’re coming in in labour or there is already a complication, some of these complications could have been prevented had you come for antenatal care.”

Ngidi said access to maternity care remains a challenge, particularly for women in rural and under-resourced communities. Some women face long distances to clinics, while public hospitals often have to care for far more patients with limited staff and equipment. There are not enough midwives in the country.

However, Ngidi said a lack of resources should not mean women receive poor treatment. She urged health-care workers to:

“I encourage pregnant women to attend antenatal care from early in their pregnancy, learn the warning signs of complications and have a birth partner where possible.”