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. ### Competing Interest Statement NO authors have competing interests Enter: The authors have declared that no competing interests exist. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: N/A I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable The data cannot be published because it is data from the registry of the Ministry of Public Health of the Dominican Republic, it has to be requested from the institution.