Disruptions in the use of maternal health services during the COVID-19 pandemic in 2020: experiences of 37 health facilities in low- and middle-income countries – Haiti


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 COVID-19 Intersite Syndromic Surveillance Working Group


The COVID-19 pandemic has heterogeneously affected the use of basic health services around the world, with disruptions in some countries starting at the onset of the emergency in March 2020. These disruptions occurred both from supply and demand side of health care, and have often been linked to shortages of resources to provide care and low patient participation associated with mobility restrictions and fear of contracting COVID-19 in institutions. In this article, we assess the impact of the COVID-19 pandemic on maternal health service use using a time series modeling approach developed to monitor health service use during pandemic using routinely collected health information systems data. We focus on data from 37 health facilities supported by non-governmental organizations in Haiti, Lesotho, Liberia, Malawi, Mexico and Sierra Leone. Overall, our analyzes indicate a significant decrease in first antenatal care visits in Haiti (18% decrease) and Sierra Leone (32% decrease) and institutional deliveries in all countries except Malawi. from March to December 2020. Different strategies have been adopted to maintain continuity. maternal health services, including communication campaigns, continuity of community health worker services, human resource capacity building to ensure adherence to international and national guidelines for frontline health workers, adaptation of spaces for safe distancing and the availability of personal protective equipment. We use a local perspective, providing a pre-pandemic context and reporting on results and country strategies, to stress the importance of developing context-specific interventions to design effective mitigation strategies.

Summary box

  • Current evidence from low- and middle-income countries, though limited, points to a decline in institutional deliveries, and early antenatal care visits were common in the early months of the COVID-19 pandemic.

  • In this study, we present new data on the use of maternal health services in health facilities supported by non-governmental organizations in Haiti, Lesotho, Liberia, Malawi, Mexico and Sierra Leone from March to December 2020, compared to up to 4 years of prior health. service usage data.

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

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

  • There is no single way to address the new challenges posed by the pandemic, which is why taking into account context-specific factors is essential to ensure effective interventions that mitigate the various impacts of the pandemic.


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