Global changes in maternity care provision during the COVID-19 pandemic: A systematic review and meta-analysis

Townsend, Rosemary; Chmielewska, Barbara; Barratt, Imogen; Kalafat, Erkan; Meulen, Jan van der; Gurol‐Urganci, Ipek; O’Brien, Pat; Morris, Edward; Draycott, Tim; Thangaratinam, Shakila; Doaré, Kirsty Le; Ladhani, Shamez; Dadelszen, Peter von; Magee, Laura A.; Khalil, Asma

doi:10.1016/j.eclinm.2021.100947

Cited by 131 publications

(117 citation statements)

References 80 publications

(205 reference statements)

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“…Likewise, one of the individual characteristics that has been most influential in terms of new barriers created by the pandemic is fear of contagion [83][84][85][86]88,89,94,95,97], an aspect that has been discussed in many publications, including opinion articles [113,[137][138][139][140][141][142], and also played a highly significant role in previous epidemics as a factor causing problems or delays in seeking medical care [2,21,24,26,72,76,101,108,143,144]. Other factors reported include the stigma associated with seeking care [84,89,93,94,97], also described in other publications [109,145], and users playing down the need for medical treatment [84,94,98] and perceiving a lack of response on the part of the health services [85,88].…”

Section: Discussionmentioning

confidence: 99%

Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review

Pujolar-Díaz

Oliver-Anglès

Vargas

et al. 2022

IJERPH

159

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The COVID-19 pandemic and the measures adopted are having a profound impact on a major goal of public healthcare systems: universal access to health services. The objective is to synthesize the available knowledge on access to health care for non-COVID-19 conditions and to identify knowledge gaps. A scoping review was conducted searching different databases (Medline, Google Scholar, etc.) for original articles published between December 2019 and September 2021. A total of 53 articles were selected and analyzed using the Aday and Andersen framework as a guide. Of these, 37 analyzed changes in levels of use of health services, 15 focused on the influencing factors and barriers to access, and 1 studied both aspects. Most focused on specific diseases and the early stages of the pandemic, based on a review of records. Analyses of the impact on primary care services’ use, unmet needs or inequalities in access were scarce. A generalized reduction in the use of health services was described. The most frequent access barrier described for non-COVID-19 conditions related to the services was a lack of resources, while barriers related to the population were predisposing (fear of contagion, stigma, or anticipating barriers) and enabling characteristics (worse socioeconomic status and an increase in technological barriers). In conclusion, our results show a general reduction in services’ use in the early stages of the pandemic, as well as new barriers to access and the exacerbation of existing ones. In view of these results, more studies are required on the subsequent stages of the pandemic, to shed more light on the factors that have influenced access and the pandemic’s impact on equity of access.

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Section: Discussionmentioning

confidence: 99%

Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review

Pujolar-Díaz

Oliver-Anglès

Vargas

et al. 2022

IJERPH

159

View full text Add to dashboard Cite

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“… 4 , 5 , 6 In addition, many settings experienced changes in healthcare access and availability. 7 A recent meta-analysis identified 16 studies assessing the impact of the COVID-19 pandemic on preterm birth, 12 of which were conducted in high-income countries (HIC). 8 Although these individual studies reported conflicting findings, a subgroup analysis of the HIC studies suggested some evidence of a significant decrease in the incidence of preterm birth following the start of the COVID-19 pandemic.…”

Section: Introductionmentioning

confidence: 99%

Preterm birth after the introduction of COVID-19 mitigation measures in Norway, Sweden, and Denmark: a registry-based difference-in-differences study

Oakley

Örtqvist

Kinge

et al. 2022

American Journal of Obstetrics and Gynecology

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Background Although some studies have reported a decrease in preterm birth following the start of the COVID-19 pandemic, the findings are inconsistent. Objective This study aimed to compare the incidences of preterm birth before and after the introduction of COVID-19 mitigation measures in Scandinavian countries using robust population-based registry data. Study Design This was a registry-based difference-in-differences study using births from January 2014 through December 2020 in Norway, Sweden, and Denmark. The changes in the preterm birth (<37 weeks) rates before and after the introduction of COVID-19 mitigation measures (set to March 12, 2020) were compared with the changes in preterm birth before and after March 12 from 2014 to 2019. The differences per 1000 births were calculated for 2-, 4-, 8-, 12-, and 16-week intervals before and after March 12. The secondary analyses included medically indicated preterm birth, spontaneous preterm birth, and very preterm (<32 weeks) birth. Results A total of 1,519,521 births were included in this study. During the study period, 5.6% of the births were preterm in Norway and Sweden, and 5.7% were preterm in Denmark. There was a seasonal variation in the incidence of preterm birth, with the highest incidence during winter. In all the 3 countries, there was a slight overall decline in preterm births from 2014 to 2020. There was no consistent evidence of a change in the preterm birth rates following the introduction of COVID-19 mitigation measures, with difference-in-differences estimates ranging from 3.7 per 1000 births (95% confidence interval, −3.8 to 11.1) for the first 2 weeks after March 12, 2020, to −1.8 per 1000 births (95% confidence interval, −4.6 to 1.1) in the 16 weeks after March 12, 2020. Similarly, there was no evidence of an impact on medically indicated preterm birth, spontaneous preterm birth, or very preterm birth. Conclusion Using high-quality national data on births in 3 Scandinavian countries, each of which implemented different approaches to address the pandemic, there was no evidence of a decline in preterm births following the introduction of COVID-19 mitigation measures.

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“…Maternal and child health care services need to be sustained as these require regular follow-up and a continuous supply of medicines [ 10 ]. A recent systematic review and meta-analysis reported that during the COVID-19 pandemic there was about a 38% decline in antenatal care (ANC) appointments globally [ 11 ]. Another scoping review concluded that prenatal care visits declined during the pandemic [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 on Antenatal Care Utilization Among Pregnant Women in Qassim, Saudi Arabia

Rabbani¹,

Saigul²,

Sulaiman³

et al. 2021

Cureus

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Background and objectives Coronavirus disease 2019 (COVID-19) pandemic has affected routine service delivery which might affect antenatal care (ANC) utilization among pregnant women. This study aimed to assess the proportion of missed appointments among pregnant women in the Qassim region of Saudi Arabia during the COVID-19 pandemic. Methods A facility-based cross-sectional survey was conducted among pregnant women admitted for delivery in Maternity and Children Hospital (MCH), Buraidah. Data were collected on socio-demographics, obstetric history, missed appointments and reasons for missing the appointment. Analysis was carried out in Statistical Package for the Social Sciences (SPSS), version 21.0 (IBM Corp., Armonk, NY). Medians with interquartile range (IQR) were presented for continuous variables and frequency and proportions for categorical variables. Logistic regression was used to assess the factors associated with the missed appointment. Results A total of 400 women were included in the study. About one-third (30%) of the women had missed at least one ANC appointment in their current pregnancy. The most common reasons for missing the appointments in primary care and hospitals, respectively, were: fear of infection 52% and 47%, facility not working usual 25% and 7.5%, fear of infection to child 19% and 17%. Family size and gravidity were the significant factors associated with missed appointments in our study. Conclusions Nearly one-third of women missed their ANC appointments during the COVID-19 pandemic. Major reasons were related to COVID-19 fear and its effect on services. This calls for proper health communication in the general population and delivering routine care with evidence-based guidelines to maintain continuity of care.

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Global changes in maternity care provision during the COVID-19 pandemic: A systematic review and meta-analysis

Abstract: Interpretation: Reduced maternity healthcare-seeking and healthcare provision during the COVID-19 pandemic has been global, and must be considered as potentially contributing to worsening of pregnancy outcomes observed during the pandemic.

Cited by 131 publications

References 80 publications

Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review

Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review

Preterm birth after the introduction of COVID-19 mitigation measures in Norway, Sweden, and Denmark: a registry-based difference-in-differences study

Impact of COVID-19 on Antenatal Care Utilization Among Pregnant Women in Qassim, Saudi Arabia

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