Abstract
BACKGROUND: COVID-19 infection in pregnant women was known to be associated with increased morbidity and mortality in Latin America and the Caribbean as a consequence of comorbidity and disruption in the supply and use of health services. METHODS: A multi-country qualitative study was carried out in Chile, Colombia, and Ecuador to investigate the factors contributing to maternal mortality in the period March 2020 - July 2021. Four sources were analyzed: health policy documents and interviews with decision-makers, service providers of health and relatives of women who died due to maternal causes during the aforementioned period. The information collected was coded according to dimensions of the SURE Collaborative model (Supporting the Use of Research Evidence Collaborative) for the analysis of the implementation of health policies; and their implementation was analyzed by applying the Three Delays model. Sixty-two policy documents were analyzed, and 21 interviews with decision makers, 30 interviews with service providers and 28 interviews with relatives of women who died from maternal causes were conducted. RESULTS: The most relevant findings were the change in the maternal and reproductive health care model with the disruption of primary health care; the prioritization of emergency care for patients affected by COVID-19; and the fear of pregnant women to seek health services. The atomization of health management and the problems of communication/dissemination of the measures aimed at the general population and health teams generally undermined the provision of quality maternal and reproductive health services.This was exacerbated by socioeconomic vulnerability and lack of systematic policy implementation, as exemplified by the uneven rollout of telemedicine and home visits. Resource and skill gaps affected both the healthcare system and service users, particularly impacting the third delay in the maternal and reproductive health continuum. Deficiencies in infrastructure, supplies, human resources, and their protection further compounded these challenges. CONCLUSION: Various factors affected the availability, use, and quality of maternal, and reproductive health services during the COVID 19 pandemic. Access to timely quality maternal health care was severely affected. STUDY REGISTRATION: The study protocol was registered on the OSF storage website (Chapman et al. 2022. https://doi.org/10.17605/OSF.IO/36JQD ).