From Pandemic to Progress: Maternal Health Resilience in the post COVID-19 era in Tamil Nadu, India

Abstract

Background and Objectives The COVID-19 pandemic considerably impacted emergency medical services (EMS), particularly in the context of maternal care. In response, the government made significant investments in both EMS and maternal health during the pandemic. This study aims to evaluate maternal and childbirth outcomes, specifically during the resilient period, by analyzing the long-term effects of the pandemic on healthcare delivery. Data and Methods The research analyzed key metrics related to emergency medical services for pregnancy, including call volume, response and transfer times, hospital handoff times, and ambulance travel distances. Maternal outcomes assessed included mortality rates, institutional childbirth, home deliveries, miscarriages, vaginal complications, and C-section rates. Data was sourced from the Tamil Nadu State Control Room registry, covering historical data from Jan 2017 including the pandemic phases in 2020–2022 and the subsequent resilient period in 2023-24. This study employs time-series analysis to compare the distribution of daily key metrics of EMS during eight pandemic phases with the average daily frequency during the pre-pandemic period. An effect size measure is then used to quantify the improvement in maternal healthcare outcomes and EMS metrics. Results Throughout the various stages of the pandemic, there was a notable increase in call volume related to women. Despite this, there were significant improvements in response times, transfer times, and hospital handoff times. In comparison to the corresponding period before the pandemic, maternal and childbirth outcomes saw marked enhancements during the post pandemic phase in 2023 and resilient phase in 2024. Specifically, the maternal mortality rate dropped by 19%, with 37 deaths per 100,000 live births, significantly lower than the national average of 97 deaths per 100,000 live births. Additionally, the rates of infant mortality, neonatal mortality, miscarriages, complicated vaginal births, and home deliveries decreased by 19.35%, 17.03%, 28.02%, 19.23%, and 36.05%, respectively. Conclusions: Government investments during the pandemic, along with the sustained focus on maternal health programs, appear to have provided substantial support to pregnant women and newborns. The reproductive health of women in Tamil Nadu does not seem to have been adversely impacted by the pandemic.