Abstract
BackgroundThe SARS-CoV-2 pandemic in India has adversely affected many aspects of population health. We need detailed evidence of the impact on reproductive health in India so that lessons can be learnt.MethodsHospital-based repeated monthly survey of nine severe maternal complications and death in 15 hospitals across five states in India covering a total of 202,986 hospital births, December-2018 through to May-2021. We calculated incidence rates (with 95% confidence intervals (CIs)) per 1000 hospital births, case-fatality and rate ratios (RR) with 95% CIs. Linear regression was used to examine the association between the Government Response Stringency Index (GRSI) for India and changes in hospital births, incidence and case-fatality.FindingsThere was a significant decrease in hospital births per month during the pandemic period with a 4.8% decrease per 10% increase in the GRSI scores (p < 0.001). The overall incidence of severe complications in the pandemic period was not significantly different from the pre-pandemic period, but hospital admissions from septic abortion was 56% higher (RR=1.56; 95% CI=1.22–1.99; p < 0.001). The overall case-fatality of complications increased by 23% (RR=1.23; 95% CI=1.03–1.46; p = 0.022) and remained high across the different phases of the pandemic with a notable significant increase in deaths from heart failure in pregnancy.InterpretationOur study supports the legitimacy of the calls made to maintain sexual and reproductive health services as essential services during the pandemic. Lessons learnt should be used to avert the ongoing reproductive health crisis while India plans to manage a third wave of the pandemic.FundingThe MaatHRI platform and this study are funded by a Medical Research Council Career Development Award to MN (Ref:MR/P022030/1). The funder has no role in the study design, data collection, analysis, or writing the paper
Highlights
The severe acute respiratory syndrome caused by the Coronavirus 2 (SARS-CoV-2) pandemic has claimed many lives across the world with many countries going through a second or third wave of infection
The overall incidence rate for severe maternal complications in the 15 hospitals across the five Indian States was 123.05 per 1000 hospital births and about 1 in 25 women who presented with a complication died
The study showed that births in the 15 study hospitals across five states in India decreased by 4.8% per 10% increase in the Indian Government Response Stringency Index (GRSI). (p < 0.001)
Summary
The severe acute respiratory syndrome caused by the Coronavirus 2 (SARS-CoV-2) pandemic has claimed many lives across the world with many countries going through a second or third wave of infection. List of abbreviations: CIs, Confidence Intervals; DIC, Disseminated intravascular coagulation; FIGO, International Federation of Gynaecology and Obstetrics; GRSI, Government Response Stringency Index; MaatHRI, Maternal and perinatal Health Research collaboration, India; PPH, Postpartum haemorrhage; RR, Rate ratios; SARS-CoV-2, Severe acute respiratory syndrome caused by the Coronavirus 2; WHO, World Health Organisation. Existing studies from India are unable to provide detailed evidence of the impact on reproductive health in the country and the trends across the first and second waves. Lessons learnt should be used to avert the ongoing reproductive health crisis while India plans to manage a third wave of the pandemic. The funder has no role in the study design, data collection, analysis, or writing the paper
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