The COVID-19 pandemic has had a profound impact on health-care systems globally and potentially on maternal and neonatal outcomes, with an increase in maternal deaths, stillbirths and maternal depression.
A recently released systematic review, published in The Lancet Global Health Journal, titled “Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis” has indicated that the rates of stillbirth and maternal deaths rose by around a third during the COVID-19 pandemic with outcomes showing a considerable disparity in stillbirths between high and low resource settings.
The review, which analysed data from 40 studies across 17 countries, reveals that the collateral effects of the COVID-19 pandemic on maternal and perinatal health are not limited to the morbidity and mortality caused directly by the disease itself.
“The disruption caused by the COVID-19 pandemic has led to avoidable deaths of both mothers and babies. Policymakers and health-care leaders must urgently investigate robust strategies for preserving safe and respectful maternity care, even during the ongoing global emergency,” says The Lancet review introduction.
Population Foundation of India’s analysis of the Health Management Information System (HMIS) data on maternal health outcomes between April 2020 to June 2020, compared to the same period in 2019, revealed a significant decline in several maternal health indicators.
There was a 27 per cent drop in pregnant women receiving 4 or more Antenatal Care sessions, a 28 per cent decline in institutional deliveries and 22 per cent decline in prenatal services during this period.
Global lockdowns, disruption in maternal health services, reduction in health-seeking behaviour, and fear of getting infected from health providers added to pregnancy risks and led to worsened health outcomes for women and infants. An increase in reported maternal anxieties could be an outcome of reduced medical attendance, limited permissible movement and lack of childcare access during lockdowns.
The review also acknowledges that unequal digital access in low and middle-income countries made remote consultations less feasible leading to disruption in preventive antenatal care for vulnerable groups.
Going forward, there is an urgent need to prioritise safe, accessible, and equitable maternity care in COVID-19 response and recovery efforts as well as in future health crises. The increase in domestic violence during the pandemic could have also contributed to the increase in maternal mortality. School closures and loss of employment during the pandemic led to an increase in the caregiving burden and loss of economic security among several women.
As the review rightly states, “the resultant financial and time constraints are likely to have far-reaching consequences for mothers’ physical, emotional, and financial health during pregnancy and in the future”.
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Commenting on the report, Poonam Muttreja, Executive Director, Population Foundation of India said, “As the ramifications of the pandemic and its subsequent lockdown become clearer, there is an urgent need to ensure that maternal health services remain integral to our public health system’s response in any emergency situation. We must ensure that our vulnerable populations and communities are not negatively affected. Women’s health is often impacted adversely during humanitarian crises and must be highlighted in any emergency response.”
To quote the article, “there remain opportunities to be seized as well as challenges to be faced as we work to end the grip of the pandemic on our global community.”
