Characterization of maternal mortality and severe maternal morbidity before and during covid-19: an analysis for the Dominican Republic

The Covid-19 pandemic disturbed the delivery of health services, which included obstetric care, in many parts of the word. In countries where maternal mortality was already elevated before the pandemic, this disruption brought about catastrophic events. Using data from the Sistema Nacional de Vigilancia Epidemiológica (SINAVE) of the maternal morbidity and mortality of the Dominican Republic, this paper estimated the severe maternal morbidity rate and the maternal mortality rate by causes of death (direct, indirect, and specific causes). Mixed effects models were used to identify individual and contextual factors that contribute to a higher risk of dying. Results indicate that the severe maternal morbidity rate decrease from 12.1 to 10.4 per 1,000 live births in 2020 compared to 2019; however, the maternal mortality rate went from 91.4 to 124.2 per 100,000 live births in the same period. In 2021, a significant increase in morbidity and mortality was observed, registering a rate of 16.5 cases of severe maternal morbidity per 1,000 live births and a rate of 153.7 maternal deaths per 100,000 live births. Additionally, maternal mortality in the Dominican Republic is associated with the sociodemographic and economic conditions of women, revealing inequalities related to national origin, area of residence and access to health services which were worsening during the pandemic.