The coronavirus pandemic has been “catastrophic” for maternal health services, an expert has warned, as a new study shows that the number of women giving birth in health facilities in Nepal has plummeted during lockdown.
Surveys and anecdotal reports have all pointed to the fact that fewer women in developing countries have been having babies in hospitals because of disruption to health services as a result of the pandemic.
But, in what the researchers believe is the first published data, evidence from Nepal shows that the numbers have reduced by half.
A paper in the Lancet Global Health published on Monday shows that in nine hospitals across Nepal the number of babies born in hospitals fell by 52.4 per cent over lockdown: dropping from 1,261 per week before lockdown began in mid March to 651 per week in mid May.
The study also showed that more stillborn babies were born - up from 14 for every 1,000 live births at the beginning of lockdown to 21 per 1,000 in May.
And the research found that more babies died as lockdown progressed, with the neonatal mortality rate increasing from 13 per 1,000 live births to 40 per 1,000 births over the study period.
Quality of care also reduced significantly, particularly foetal heart rate monitoring and breastfeeding within one hour of birth.
Joy Lawn, one of the authors of the study and professor of maternal, reproductive and child health at the London School of Hygiene and Tropical Medicine, said the research was the first published evidence to show the impact of the indirect effects of the coronavirus pandemic.
“This is hard core, proper data which shows that in these settings there has been half the number of births in hospitals than before the pandemic. Having just half of births taking place in health facilities is really catastrophic,” she said.
Other studies have shown the effect of the pandemic on childbirth: one found that the rate of premature birth has fallen in high income countries. Other research has pointed to a post-pandemic baby boom.
Women did not come to hospital for a number of reasons. They may have been worried about picking up the virus in hospital, transport may have been shut down or they may have been unable afford to get to a health facility.
Jugmati Tharu, a woman from a marginalized community from Mid-western Nepal who delivered in one of the study hospitals just before the lockdown, told researchers: "I was quite afraid because I had heavy bleeding before the labour in the middle of night. We could not get an ambulance, and had to hire a private vehicle at a high cost.”
Sushila Bhatta, vice-mayor of Dhangadi Sub-Metropolitan municipality, said the research backed up what she had witnessed anecdotally.
“In our municipality, women fear going to hospital and most have delivered at home without skilled providers. The other reason for home birth is unavailability of ambulances. We have now procured three ambulances to improve the referral to health," she said.
Most women will have ended up giving birth at home, said Prof Lawn. “This is not like having a home birth in the west. You’re up a mountain in a mud hut and you’re on your own. If something goes wrong then you’re stuffed,” she said.
Before lockdown Nepal was seen as an “exemplar” in terms of its record in improving maternal and child health care, with an increase in the proportion of women giving birth in hospital or health facilities being one of the key drivers.
Prof Lawn said the Nepalese experience would most likely be reflected in other developing countries. Research showed that during the 2014-16 Ebola outbreak in West Africa there was a marked reduction in access to essential health services such as maternal care and life-saving immunisation.
Prof Lawn warned that the impact of these indirect effects may be long lasting. “We know from Ebola that people don’t come rushing back [to health services],” she said.
But after the outbreak donors were keen to help the three affected countries. Prof Lawn said high income countries would be too focused on their own problems.
“My concern is that the coronavirus will be a longer, bigger hit. High income countries will be less likely to invest in low income health systems,” she said.
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