Shimla. A new large-scale MaatHRI study has revealed a significant increase in cases and deaths from severe maternal complications in India during the COVID-19 pandemic.
It highlights the importance of accessing reproductive health services by women promptly without delay.
India experienced a devastating second wave of SARS-CoV-2 infections. In addition, national and regional lockdowns restricted access to wider healthcare, including sexual and reproductive health services. Researchers from the MaatHRI collaboration found evidence that these disruptions have caused an increase in unsafe abortions, severe complications in pregnancy, and maternal death in India. The results are published in EClinicalMedicine (DOI: 10.1016/j.eclinm.2021.101063).
The study data came from 15 hospitals across five states in India, and included a total of 202,986 hospital births for the period December 2018 through to May 2021 (15 months pre-pandemic and 15 months during the pandemic).
For each month, the researchers counted the number of cases and deaths from nine types of maternal complications (such as eclampsia and postpartum haemorrhage).
In addition, monthly Government Response Stringency Index (GRSI) scores for India were used to measure how the strictness of restrictions imposed to control the SARS-CoV-2 outbreak effected hospital births, severe maternal complications and death.
Key results:
During the study period, a total of 24,978 women were admitted to the 15 hospitals with at least one of the surveyed pregnancy complications, and 1,020 of them died.
The number of hospital births significantly decreased during the pandemic.
Compared with the corresponding month in the pre-pandemic period, hospital births decreased by nearly 5% for every 10% increase in GRSI score.
During the pandemic, the overall incidence of maternal complications increased by 10%. This was mainly due to a significant rise in hospital admissions from septic abortion, which were 56% higher during the pandemic.
The overall case fatality from the nine complications surveyed increased by 23% during the pandemic period compared with the pre-pandemic period.
In particular, there was a doubling in the case fatality for heart failure in pregnancy, increasing from 29 to 58%
According to the research team, the results indicate that lockdown and other restrictions had a strong negative impact on the number of births taking place in hospitals across India.
This would have affected access to care at childbirth, including emergency obstetric services. In addition, the quality of hospital care during the pandemic may have been compromised due to shortage of healthcare staff and reallocation of medical supplies.
Key messages:
Special ambulance and telemedicine services could be made available to women for accessing timely care. Assam has made immense effort to manage the COVID-19 pandemic, but policy makers need to be aware of the indirect consequences of the pandemic on women’s health and survival.
Pregnant women and their families need to be aware about the increased risk of complications and death if they do not access appropriate health facilities.
The study was conducted through Maternal and perinatal Health Research collaboration, India (MaatHRI https://www.npeu.ox.ac.uk/maathri): a India-UK collaboration for maternal and perinatal health research.
The MaatHRI platform and this study was funded by a Medical Research Council Career Development Award to Associate Professor Manisha Nair, University of Oxford.
COLLABORATORS FROM Himachal Pradesh:
Dr Omesh Bharti (padamshree awardee, Field Epidemiologist, Parimahal Shimla
Dr Ashok Verma (Prof OBG) Dr Rajendra Prasad Govt Medical College Kangra at Tanda, H.P
Dr Sita Thakur (Prof OBG) Dr Rajendra Prasad Govt Medical College Kangra at Tanda, H.P
Principal Investigator at Oxford University: Dr Manisha Nair
