Excess maternal deaths and maternal mortality ratios during the COVID-19 pandemic period: a global country-level counterfactual modelling study

Background: Maternal mortality remains uneven globally, and the COVID-19 pandemic disrupted maternal health services through direct infection-related risks and indirect health-system pathways. We estimated country-level deviations in maternal deaths and maternal mortality ratios (MMR) during 2020-2023 relative to pre-pandemic trends. Methods: We used WHO/UN MMEIG model-based country-level estimates of maternal deaths and MMR from 2000-2019 to fit an ensemble n-sub-epidemic forecasting model. We generated no-pandemic counterfactual projections for 2020-2023 and compared them with WHO/UN MMEIG estimates for the same years. Excess was defined as the positive difference between the WHO/UN MMEIG