The coronavirus outbreak has badly affected maternal care services, drastically lowering institutional deliveries as well as antenatal and postnatal care services in Bangladesh.
The COVID-19 circumstances are likely to take its toll on the lives of mothers, experts said, although officials said that the service delivery was improving after the coronavirus situation improved in recent weeks.
‘COVID-19 has badly disrupted the maternal care services,’ said Directorate General of Family Planning director for maternal and child health Mohammad Sharif.
‘The impact will be known after the year-ending data will be out, but we fear a surge in maternal mortality,’ he told New Age.
Bangladesh saw the emergence of COVID-19 in March, prompting the government to announce a lockdown from March 26 to May 30 to prevent the spread of the infection.
For fear of contracting the coronavirus, pregnant mothers largely avoided health facilities, resulting in a drastic fall in institutional deliveries and in seeking antenatal and postnatal care services, according to experts and studies.
Though the disruptions in other health services due to the coronavirus outbreak were noticed and discussed a lot, but critical maternal health services received relatively less attention, they said.
A study by the research organisation Population Council has analysed the impact of COVID-19 on maternal health services in Bangladesh, examining national and district trends in antenatal care, institutional deliveries, and postnatal care between January and July and compared those with the trends in 2019.
It found that after the lockdown was announced, all types of institutional deliveries — normal, caesarean section and active management of the third stage of labour – declined by around 40 per cent in April 2020, compared to the same month in 2019.
Despite a slight recovery, institutional deliveries remained 10 per cent to 20 per cent lower in May, and then 10 per cent to 15 per cent lower in June and July 2020 than they were during the same months the previous year.
The maternal mortality rate in Bangladesh is 196 per 100,000 live births, according to the Bangladesh Maternal Mortality and Health Care Survey 2016 conducted by the National Institute of Population Research and Training.
Haemorrhages and eclampsia accounted for 54 per cent of all maternal deaths in Bangladesh, the survey revealed.
Obstetrical and Gynaecological Society of Bangladesh president Sameena Chowdhury said that in normal times about 15 per cent of pregnancies turned complex and the situation was likely worse amid the COVID-19 prevalence.
‘Home delivery brings about dire consequences to mothers, causing the events of haemorrhage, eclampsia – two top causes of maternal deaths, among others,’ she said.
‘We have not any big data, but we fear the maternal mortality will rise due to the increased number of home delivery,’ she said.
Sameena said that their organisation analysed maternal mortality at four medical college hospitals — Dhaka, Chattogram, Rangpur and Faridpur — from March to July and found that the rate went up by 50 per cent at the hospitals also.
‘Due to the fearing coronavirus, mothers and their families did not want to go to hospitals for prenatal and postnatal care, resulting in complexity by the time and ultimately many had died,’ she said.
At least four antenatal care visits are crucial for mothers and babies, but the trend of the antenatal care services was far lower amid the outbreak compared to normal times, according to the Population Council study.
The study found a clear disruption in antenatal care services with the onset of COVID-19 and during the lockdown, specifically when comparing March through May for both years.
Antenatal care visits were 50 per cent lower in April 2020 compared to April 2019.
Even after signs of recovery in the coronavirus situation during June and July 2020, the trend remained 20 per cent to 25 per cent lower than in July 2019, particularly for the second antenatal care, third antenatal care and fourth antenatal care visits.
The trend was no different for postnatal care as well, found the study.
Postnatal visits were as much as 40 per cent lower in April 2020 compared to April 2019 and even with recovery in June and July 2020, the visits remained 20 per cent to 25 per cent lower than they were in June and July 2019.
Maternal care services in neighbouring districts of Dhaka, northern districts and north-eastern districts witnessed massive disruptions, according the study.
DGFP director Mohammad Sharif said that they imparted training to their health service providers online and the service delivery also increased after the COVID-19 situation improved in recent weeks.
But maternal care services are still low, compared to the time before the COVID-19 outbreak, he said.
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