Midwife-led Pandemic Telemedicine Services for Maternal Health and Gender-Based Violence Screening in Bangladesh: An Implementation Research Case Study

Abstract

Background The COVID-19 pandemic disrupted maternal and newborn health services in Bangladesh, increasing the large gaps in service utilization that existed prior to the pandemic. As part of its response, Bangladesh initiated remote antenatal and postnatal care telemedicine services led by midwives in 36 sub-district hospitals across five of Bangladesh’s 64 districts. Gender-based violence screening and referral were integrated into the service to address a reported rise in violence following the country’s pandemic lockdown. Methods Mixed-methods implementation research was used to develop a case study describing the design and implementation of the telemedicine program. Qualitative analysis comprised document review, key informant interviews, and focus group discussions. Quantitative analysis employed descriptive statistics to compare service use trends before and after implementation. Results Challenges included the unanticipated need to introduce a scheduling system in all intervention hospitals and that many women were not reachable by phone due to lack of access or network coverage. Some women were also reluctant to discuss gender-based violence. However, maternity care service use increased, with 19%-31% more women receiving skilled maternal and newborn care than otherwise would have. In addition, there was a doubling of cases of postpartum hemorrhage and eclampsia that were identified and effectively responded to. Conclusions Maternal health and gender-based violence telemedicine led by midwives was an effective, low-cost intervention in Bangladesh for addressing pandemic and pre-pandemic gaps in service use. Other low and middle-income countries planning to implement remote maternal health interventions via midwives should consider whether a scheduling system needs to be introduced, as well as limitations around mobile phone access and connectivity. Future research should include care quality oversight and improvement.