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. 2021 May 11:11:05010.
doi: 10.7189/jogh.11.05010.

The perfect storm: Disruptions to institutional delivery care arising from the COVID-19 pandemic in Nepal

K C Ashish  1 , Stefan Swartling Peterson  1   2 , Rejina Gurung  1   3 , Alkistis Skalkidou  1 , Jageshwar Gautam  4 , Honey Malla  3 , Punya Paudel  5 , Kumari Bhattarai  5 , Nisha Joshi  5 , Bhim Singh Tinkari  5 , Shree Adhikari  6 , Durgalaxmi Shrestha  7 , Binda Ghimire  8 , Seema Sharma  9 , Laxmi Khanal  10 , Sunil Shrestha  10 , Wendy Jane Graham  11 , Mary Kinney  12
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The perfect storm: Disruptions to institutional delivery care arising from the COVID-19 pandemic in Nepal

K C Ashish et al. J Glob Health. .

Abstract

Background: The COVID-19 pandemic has led to system-wide disruption of health services globally. We assessed the effect of the pandemic on the disruption of institutional delivery care in Nepal.

Methods: We conducted a prospective cohort study among 52 356 women in nine hospitals to assess the disruption of institutional delivery care during the pandemic (comparing March to August in 2019 with the same months in 2020). We also conducted a nested follow up cohort study with 2022 women during the pandemic to assess their provision and experience of respectful care. We used linear regression models to assess the association between provision and experience of care with volume of hospital births and women's residence in a COVID-19 hotspot area.

Results: The mean institutional births during the pandemic across the nine hospitals was 24 563, an average decrease of 11.6% (P < 0.0001) in comparison to the same time-period in 2019. The institutional birth in high-medium volume hospitals declined on average by 20.8% (P < 0.0001) during the pandemic, whereas in low-volume hospital institutional birth increased on average by 7.9% (P = 0.001). Maternity services halted for a mean of 4.3 days during the pandemic and there was a redeployment staff to COVID-19 dedicated care. Respectful provision of care was better in hospitals with low-volume birth (β = 0.446, P < 0.0001) in comparison to high-medium-volume hospitals. There was a positive association between women's residence in a COVID-19 hotspot area and respectful experience of care (β = 0.076, P = 0.001).

Conclusions: The COVID-19 pandemic has had differential effects on maternity services with changes varying by the volume of births per hospital with smaller volume facilities doing better. More research is needed to investigate the effects of the pandemic on where women give birth and their provision and experience of respectful maternity care to inform a "building-back-better" approach in post-pandemic period.

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Conflict of interest statement

Conflicts of interest: The authors completed the ICMJE Unified Competing Interest form (available upon request from the corresponding author) and declare no conflicts of interest.

Figures

Figure 1
Figure 1
Respectful provision of care by volume of birth.
Figure 2
Figure 2
Respectful experience of care by volume of birth.
See this image and copyright information in PMC

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