COVID-19 has turned back decades of progress on reducing maternal and child deaths
New research has revealed the impact of healthcare disruption during the pandemic on maternal and child health. The Global Financing Facility’s Tashrik Ahmed and Bruno Rivalan discuss the implications.
- 7 October 2022
- 8 min read
- by Linda Geddes
At the beginning of the pandemic, scientists predicted widespread healthcare disruption, and a possible increase in maternal and child deaths as a result. How does your research suggest those predictions played out?
Tashrik Ahmed: There were a variety of scenarios that were put forth at the beginning of the pandemic. One of the most cited was a paper that came out of Johns Hopkins University in the US, which predicted a roughly 25% drop in essential maternal and child health services over six months.
We see this work as an extension of that modelling to understand the real impact of the pandemic on health services and how this has affected women and children in the world's poorest communities. What we're finding is that most of the 18 countries in our analysis experienced disruptions in the order of 2–5%, which is not negligible. We've gone through decades of reducing maternal and child mortality, so any reversal of that is a major concern.
Women and children in the poorest communities were hit hardest. Women, who often hold more insecure jobs, became unemployed and were no longer able pay for childcare. They also lost access to sexual and reproductive health services while school closures increased unwanted pregnancies among young girls.
Why is it important to gather this kind of data?
Tashrik Ahmed: From the very onset of COVID-19, at the Global Financing Facility (GFF) we have been very concerned about the pandemic's far-reaching and potentially devastating consequences on women and children.
We knew that the pandemic could pose a very large threat to the ability of some low- and middle-income countries to achieve universal health coverage – ensuring everyone has access to essential health care without suffering financial hardship – and the Sustainable Development Goals, which provide a blueprint to achieve a better and more sustainable future for all. We wanted to get a sense of the impact to help countries adapt their plans to ensure continuation of essential health services and understand what we need to do as a global community to help recover some of the losses.
To achieve this, we looked at the service volume in public healthcare facilities from 18 low-and middle-income countries between January 2018 and June 2021. The ability to get data quickly during the pandemic and compare it with earlier information was really crucial. It meant we were able to say: here's what the level of utilisation should have been for the different types of reproductive, maternal and child health services that are big priorities for universal health coverage (UHC) and here's what was actually observed during the different phases of the pandemic.
We then took these percentage decreases and used a mathematical model to project corresponding increases in maternal mortality and child mortality.
What did you find?
Tashrik Ahmed: Our main finding was that, across the 18 countries we studied, these health service disruptions were estimated to correspond with increases in maternal and child deaths – more specifically with more than 100,000 deaths among children (a 3.6% increase), and more than 3,000 maternal deaths (a 1.5% increase).
It's worth noting that all countries experienced some level of disruption but there were different factors affecting disruptions and variations across countries and services. Certain countries, such as Bangladesh, experienced large disruptions across all services and were at the higher end of what we saw: up to a 15% increase in child mortality between March 2020 and July 2021. There were also some countries, such as Somalia or the Democratic Republic of the Congo, where the impact was much smaller – although this might be because we were unable to get a true baseline during the pre-pandemic period. Understanding the different drivers will require a much deeper dive into the various policies that were put in place.
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Bruno Rivalan: I think it's also important to acknowledge that the extent of the disruption varied during different phases of the pandemic. Disruption was particularly high during the early days but reduced as the COVID-19 response became more organised, and the agenda for maintaining essential health services was put forward. Some countries, including Liberia, Cote d'Ivoire and Ethiopia, invested more in protecting and maintaining essential health services for women and children and integrated that into their COVID-19 response.
Why did you focus on women and children. Are they particularly vulnerable to healthcare disruption?
Tashrik Ahmed: Women and children in the poorest communities were hit hardest. Women, who often hold more insecure jobs, became unemployed and were no longer able pay for childcare. They also lost access to sexual and reproductive health services while school closures increased unwanted pregnancies among young girls. Mothers were no longer taking their children to the doctor for fear of contracting the virus. This drop in access to services is devastating for this particular group.
There are a large number of health services that can be delayed with relative safety, and then there's a set of services that cannot. The reproductive and child health continuum represents a good portion of the services that really should not be delayed. For example, it's really important that pregnant women get antenatal care, and get it early, because there are certain types of screening that reduce morbidity and mortality throughout pregnancy and birth if you catch the problem early on. The same goes for most of the services we examined. Take child vaccinations – if you delay vaccinations, it may be difficult to find these children and catch up those vaccinations in rural communities.
Based on data from July and August 2022, we're seeing that that some countries are still experiencing disruptions. This is still a very volatile period for many countries’ health systems, especially as multiple ongoing crises are impacting country ability to build resilience.
How could these disruptions affect women's and children's health in the longer-term?
Tashrik Ahmed: They might delay and, in some cases, reverse the progress that we've been making towards the Sustainable Development Goals and universal health coverage goals. These are global benchmarks that the world has set for itself to achieve certain levels of health coverage and quality in vulnerable populations. To put that in more concrete terms, a delay in reaching these benchmarks means that more mothers and more children fall ill or die that needn't have had we reached those goals more quickly. That's the real impact that we are worried about here.
Are there lessons that countries could learn as a result of this research?
Tashrik Ahmed: COVID-19 has taught us many different lessons. Certainly, there's a need for some context- or country-specific measures to safeguard essential services in the event of a health emergency, and to have these safeguards integrated into pandemic preparedness and response activities.
Specifically related to our research, one of the most important lessons is that country-owned data can enable real-time monitoring of these types of disruptions. Based on data from July and August 2022, we're seeing that that some countries are still experiencing disruptions in terms of antenatal care visits, and in some countries BCG vaccination coverage is again dropping due to supply challenges. This is still a very volatile period for many countries' health systems, especially as multiple ongoing crises are impacting country ability to build resilience.
Bruno Rivalan: Another thing that has come out of this research, and has been validated by ongoing dialogue with countries, is the need for a broader policy focus and action on four key areas.
First, there is still low investment in, and priority given, to women's, children's and adolescents' health. Through partnerships such as the GFF, we are able to support countries in building health systems and community primary health care with women and children at the centre and advocate for more investment around priorities. For example, in Burkina Faso the government prioritised investments to deliver better care, build more health facilities and train the health work force.
Second, how do we make more resources available to move frontline services closer to communities, and strengthen health centres and the capacity of community health workers? In Uganda, the government prioritised the inclusion of family planning into essential health service packages and incentivised frontline health providers to deliver modern methods of contraception and counselling. This resulted in more women and adolescents accessing family planning services.
Third, how do we build a system for health, rather than just a health system? For instance, in Côte d'Ivoire, we're working with the government to build a 'one-stop' system, where the country's poorest families will be able to register the births of their children, enrol in social security, and access primary health care, all in one facility.
Finally, how do we strengthen our partnerships and align support behind country priorities? The GFF has been working closely with partners including Gavi to help strengthen systems and health financing. For example, the collaboration with Gavi, the Global Fund, World Health Organization, and the World Bank under the Global Action Plan's Health Financing Accelerator, focuses on financing reforms toward universal health care.
Tashrik Ahmed is a results specialist with the Global Financing Facility for Women, Children, and Adolescents, working with countries to improve routine data collection for decision-making and measuring reproductive, maternal, and newborn health outcomes.
Bruno Rivalan, manages the donor relations and resource mobilisation efforts of the Global Financing Facility. He also supports GFF leadership and governance on the design, and launch of new approaches and partnership for delivering of the GFF 2021-2025 strategy.
