The Perils of Covid-19 in Nepal: Implication for Maternal Health

Maternal, Neonatal and Child Health Situation

The maternal morbidity and mortality in Nepal are associated with the ‘3 delays’ i.e. delay in seeking care, reaching care and receiving care. In the early days of the lockdown the pregnant women were asked to hold their antenatal checkup (ANC) unless any danger sign is reported to avoid transmission from and to health facility. Similarly, due to uncertainty of the availability of health services, travel ban, difficult in accessing ambulance services etc. severely disrupted women to access maternal health care services which are critical life saving interventions for both women and child. Nepal has highest maternal mortality (239 per 100,000 live births) which indicates weak health care system. Therefore, it is predicted that the COVID-19 will further strain the health care system which would threat the achievement reached by Nepal in the maternal and neonatal health [5]. The GoN uplift the nationwide lockdown in July 21, 2020 however due to increased transmission of COVID-19 some regions have again imposed curfew to control community transmission. In the current setting of the quarantine and isolation measures, the United Nations (UN) has predicted likelihood of increased unwanted and unintended pregnancy which could escalate the risk of increased preventable maternal death [6]. The GoN has reported sharp increment in the home delivery during the COVID-19 pandemic, as only 50% of the pregnancies are now taking to the health facilities in compare with 70% before lockdown in March [6, 7]. A survey conducted by the United Nations Population Fund (UNFPA) in April, found 50% drop in the ANC visit by pregnant women which is a reason for worrying. Similarly, the UNFPA estimates pandemic could double or triple maternal deaths in Nepal by next year, as fewer women are up taking key services like: having skilled healthcare providers assist in births, delivering in health facilities, or accessing contraception [7].

Maternal stress increases among the pregnant women in the time of a pandemic. The social isolation and increased stress in pregnancy can also lead to adverse pregnancy consequences, such as preterm birth and low birth weight [8, 9]. The social support during the pregnancy has been observed to be protective against postpartum depression and stress [10]. Many pregnant women consider delivery at home based on fear of being exposed to infection at health care setting. The evidence does not suggest intrauterine transmission of covid 19 [11]. There should be priority in treatment to pregnant women with COVID-19 because of the risk of complications. Till now, there is no evidence that pregnant women are at most risk as compared to other general population. However, an outbreak places pregnant woman at risk of infection and death [12].

Way Forward

Maternal and child health programs at Nepal are provided through peripheral level health institutions such as; birthing centers, health post and primary health care centers. Maternal, neonatal and child health should be given special attention during this pandemic situation. Country should prioritize investment in enhancing national public health capabilities and infrastructures as they are the first line of defense in public health emergencies of international concerns. Pregnant women with respiratory illnesses must be treated with greatest concern due to increased risk of adverse outcomes. The Government must segregate antenatal, neonatal and maternal health units from identified COVID-19 cases. Home visit and counseling services should be provided through female community health volunteers (FCHVs) and peripheral health workers.

One of the powerful tools to combat COVID-19 spread and transmission is promoting good hand hygiene. The regular and thorough hands washing with soap or use of hand sanitizer are critical measures to protect infection among pregnant women, children and lactating mothers. These measures should be followed by frontiers health workers. The provinces and local levels should establish and strengthen hand hygiene facilities in all peripheral health facilities.

In this pandemic situation, there are increasing death cases related to poor maternity, neonatal and inadequate child care. The government agencies should provide appropriate relief packages to the maternal mothers and children. These packages should include nutritious foods, health care supplies and sanitation related commodities. Along with relief packages, the message for breast feeding and complementary feeding including maternal nutrition must be disseminated through appropriate media.

The maternal stress coping strategies and appropriate interventions targeting pregnant and lactating mothers should be adopted in every local levels. The concept of telemedicine services for ANC checkups should be promoted. There is a need of 24*7 hotline numbers for those pregnant women and lactating mothers who urgently want to seek advice and appropriate treatment. The health care providers must be provided with personal protective equipment (PPE) to carry out essential ANC, postnatal care and safe delivery services.