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Disruptions in maternal health service use during the COVID-19 pandemic in 2020: experiences from 37 health facilities in low-income and middle-income countries

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Zeus Aranda, Thierry Binde, Katherine Tashman, Ananya Tadikonda, Bill Mawindo, Daniel Maweu, Emma Jean Boley, Isaac Mphande, Isata Dumbuya, Mariana Montaño, Mary Clisbee, Mc Geofrey Mvula, Melino Ndayizigiye, Meredith Casella Jean-Baptiste, Prince F Varney, Sarah Anyango, Karen Ann Grépin, Michael R Law, Jean Claude Mugunga, Bethany Hedt-Gauthier, Isabel R Fulcher, on behalf of the Cross-site COVID-19 Syndromic Surveillance Working Group


The COVID-19 pandemic has heterogeneously affected use of basic health services worldwide, with disruptions in some countries beginning in the early stages of the emergency in March 2020. These disruptions have occurred on both the supply and demand sides of healthcare, and have often been related to resource shortages to provide care and lower patient turnout associated with mobility restrictions and fear of contracting COVID-19 at facilities. In this paper, we assess the impact of the COVID-19 pandemic on the use of maternal health services using a time series modelling approach developed to monitor health service use during the pandemic using routinely collected health information systems data. We focus on data from 37 non-governmental organisation-supported health facilities in Haiti, Lesotho, Liberia, Malawi, Mexico and Sierra Leone. Overall, our analyses indicate significant declines in first antenatal care visits in Haiti (18% drop) and Sierra Leone (32% drop) and facility-based deliveries in all countries except Malawi from March to December 2020. Different strategies were adopted to maintain continuity of maternal health services, including communication campaigns, continuity of community health worker services, human resource capacity building to ensure compliance with international and national guidelines for front-line health workers, adapting spaces for safe distancing and ensuring the availability of personal protective equipment. We employ a local lens, providing prepandemic context and reporting results and strategies by country, to highlight the importance of developing context-specific interventions to design effective mitigation strategies.

Summary box

  • Current evidence from low-income and middle-income countries, although limited, indicates declines in facility-based deliveries, and first antenatal care visits were common during the early months of the COVID-19 pandemic.

  • In this study, we present novel data on maternal health service use from non-governmental organisation-supported health facilities in Haiti, Lesotho, Liberia, Malawi, Mexico and Sierra Leone from March through December 2020, comparing to up to 4 years of prior health service use data.

  • We observed a significant decline in the use of maternal health services in all countries included in the study except Malawi during the COVID-19 pandemic in 2020.

  • We discuss these analytical findings in a context-specific manner by focusing on both the national COVID-19 emergency responses of governments and local health measures implemented by the health facilities included in the analysis, which likely impacted maternal health service use in these countries and worldwide.

  • There is no single way to address the new challenges brought on by the pandemic, so consideration of context-specific factors is key to ensuring effective interventions that mitigate the varied impacts of the pandemic.