Effects of COVID-19 on maternal institutional delivery: Fear of a rise in maternal mortality

Abstract

Since the outbreak of the novel coronavirus or SARS-CoV-2 (COVID-19), the word has witnessed multidimensional problems and challenges. The global social, economic and public health sectors are more vulnerable and going through an unprecedented crisis. During this overwhelm pandemic, maternal mortality could be exacerbated due to the redirection of health care services towards COVID-19. The continuous lockdown, fear of getting infected with COVID-19 and massive disruption in the provision of maternal health services (such as antenatal and postnatal care) has resulted in a significant decline in the institutional delivery rate in Bangladesh [1]. These disruptions could push back many low-and-middle-income countries (LMICs) endeavour on ensuring safe institutional deliveries. Globally, approximately 810 maternal deaths occur every day, most of which are preventable by using institutional and safe delivery [2]. In 2019, about 80 million deliveries occurred at health institutions globally [3], but this number may be reduced in a post-pandemic scenario. Pregnant women who deliver at home have an increased risk of maternal mortality due to factors such as haemorrhages, eclampsia, sepsis, and obstructed labour, etc. [4,5]. Evidence shows that 35% of all causes of antepartum, intrapartum and postpartum haemorrhage is due to unsafe home delivery practices [4-6]. Between 2010 and 2017, the maternal mortality ratio (MMR) in Bangladesh decreased substantially to 173 per 100 000 live births. Using institutional delivery with skilled health care professionals could reduce 16 to 33% of maternal deaths, globally [7,8]. Still, during this pandemic, the rate of institutional deliveries has been declining overwhelmingly. A study published in The Lancet [3] pointed out that institutional childbirth reduced by more than half in Nepal. A similar picture was presented for India [9] due to the lack of transport, fear among people and doctors, resulting in thousands in need of health care services being denied by hospitals.