Effects of the COVID-19 pandemic on the maternal mortality ratio in Mexican municipalities

Abstract

The COVID-19 pandemic intensified the vulnerability of women of reproductive age to maternal mortality. This research analyzes the impact of the pandemic on the Maternal Mortality Ratio (MMR) at the municipal level in Mexico between 2018 and 2022. A panel data set was constructed, and a Two-Way Fixed Effects (TWFE) Difference-in-Differences model, as well as an event study model, were applied to evaluate the temporal evolution of the impact. The TWFE model results show that an increase of one positive COVID-19 case per 1,000 inhabitants is associated with an increase of 0.015 maternal deaths per 1,000 live births, an effect that was more severe during 2020. The event study model reveals that, in municipalities with high COVID-19 morbidity, the MMR increased on average by 0.052 per 1,000 live births compared to untreated municipalities. Although morbidity decreased in 2021, treated municipalities maintained an average excess of 0.020 maternal deaths. These findings demonstrate the differentiated impact of the pandemic and underscore the importance of strengthening obstetric care during health emergencies.