The Impact of the COVID-19 Pandemic on Maternal Mortality Rates in Indonesia: A Retrospective Cohort Study

Abstract

Introduction: The COVID-19 pandemic has presented unprecedented challenges to healthcare systems worldwide. Early reports have indicated an increase in maternal mortality rates (MMR) in various settings. This study aims to investigate the impact of the COVID-19 pandemic on MMR in Indonesia, a populous country in Southeast Asia with a high MMR.

Methods: A retrospective cohort study was conducted using data from the Indonesian Ministry of Health's Maternal Mortality Surveillance System (MMSS). The study population included all pregnant women who delivered in Indonesia between January 1^st, 2018, and December 31^st, 2022. Women were categorized into two groups: those who delivered before the pandemic (January 1^st, 2018, to February 29^th, 2020) and those who delivered during the pandemic (March 1^st, 2020, to December 31^st  2022). The primary outcome was maternal death. Multivariable logistic regression was used to assess the association between the pandemic period and maternal mortality, adjusting for potential confounders.

Results: A total of 1,250,480 deliveries were included in the study. The MMR during the pandemic period was 155 per 100,000 live births, compared to 118 per 100,000 live births pre-pandemic. After adjusting for confounders such as maternal age, socioeconomic status, and access to healthcare, the pandemic period was independently associated with an increased risk of maternal mortality (adjusted odds ratio [aOR] = 1.32; 95% confidence interval [CI], 1.25-1.39).

Conclusion: The COVID-19 pandemic was associated with a significant increase in MMR in Indonesia. This highlights the need for continued efforts to strengthen maternal healthcare systems and ensure access to quality care, especially during public health emergencies.