New Delhi: Risk of mothers dying during pregnancy or childbirth in India has increased by more than a third during covid-19 compared with pre-pandemic instances, a review of data published in The Lancet Global Health journal has revealed.

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.

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The review included studies that investigated the impact of the pandemic on maternal death rates from middle-income countries — one from India and the other from Mexico.

“Pooled analysis of data from both studies found that the risk of mothers dying during pregnancy or childbirth was increased by more than a third compared with before the pandemic (maternal death rate: during pandemic, 530/1,237,018 pregnancies vs pre-pandemic: 698/2,224,859 pregnancies),” the study said.

Researchers reviewed data from 40 studies that were published between 1 January 2020 and 8 January 2021, representing 17 countries and with data from more than 6 million pregnancies. All the studies compared pregnancy outcomes during and before the pandemic, but studies that focused solely on SARS-CoV-2 infected women were excluded.

Of the studies included in the review, 12 reported on incidence of stillbirth. Analysis of the pooled data found chances of having a stillbirth increased by more than a quarter compared with pre-pandemic instances. Stillbirth rate during pandemic was 1,099 out of 168,295 pregnancies, while before pandemic it was 1,325 of 198,993 pregnancies.

“In resource-poor countries, even under normal circumstances, it is a challenge to provide adequate coverage for antenatal checkups, obstetric emergencies, universal institutional deliveries, and respectful maternity care. The covid-19 pandemic has widened this gap and exposed several lacunae of health-care systems worldwide, but more so in low- and middle-income countries,” said Jogender Kumar of the Postgraduate Institute of Medical Education and Research.

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.

“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,” Poonam Muttreja, executive director, PFI said.

“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,” she said.

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