Infant deaths up during Nepal lockdown

A report published online in the journal The Lancet Global Health this week revealed that the COVID-19 pandemic has caused 50% fewer women in Nepal than usual to give birth in hospitals, resulting in higher risks for premature births, stillborn deliveries and newborn deaths.

The study, conducted in nine hospitals across Nepal found that the stillbirth rate at hospitals and birthing centres increased from 14 per 1,000 before the lockdown to 21, and the neonatal mortality increased from 13 per 1,000 livebirths to 40.

‘An urgent need exists to protect access to high quality intrapartum care and prevent excess deaths for the most vulnerable health system users during this pandemic period,’ the report noted.

While the study focused on the indirect impacts of the pandemic on maternal and neonatal health service delivery, and did not attempt to calculate deaths resulting from these impacts, it warned: ‘During the COVID-19 pandemic, women and their babies (both in utero and neonates) are susceptible and at risk due to gaps in care that can result in adverse birth outcomes, including mortality.’

It continued: ‘The decrease in the number of institutional births and increase in adverse outcomes are especially concerning because of Nepal’s fragile health system, and raise

questions on policies regarding strict lockdowns in low-income and middle-income countries.’

In fact, Nepali Times had reported earlier this year that ‘many more children have died during the four months of lockdown compared to the same period last year because of lack of access to health care due to the restriction on mobility, interrupted vaccination campaigns and the lack of medicines.’

‘Initial government figures also show that a total of 204 children under 5 have died across the country during the lockdown between 14 March-14 June. This number was at a much lower 151 during the same period last year,’ our report said.

According to Lubna Baqi, Nepal Country Representative for the UN Population Fund (UNFPA): “The finding of (this week’s) study are deeply troubling. A drop in institutional deliveries by 52.4% has significant implications on health outcome as noted in the study. A further drop in institutional deliveries will have a devasting impact on maternal and newborn health.”

An online rapid assessment by UNFPA in April found a similar decline, about one-half, in deliveries in health institutions. In June, Ministry of Health Spokesperson Mahendra Shrestha said fewer than 45% of women were giving birth in facilities, down from 75% before the Coronavirus pandemic.

The Lancet study, based on monitoring in nine hospitals in Nepal, found decreases in:

- Institutional births (by roughly 50%)

- Foetal heart rate monitoring during labour

- Breastfeeding within one hour of birth

- Women being accompanied during delivery.

The authors speculate that ‘the increase in preterm birth could also be associated with the distress of COVID-19-related social restrictions, considering psychosocial stress during pregnancy .’

They add: ‘The increased proportion of admitted women having complications during admission, including preterm birth, during the COVID-19 lockdown period, might suggest that women at high risk of complications are disproportionately attending health facilities or that the number of complicated cases has increased due to delays and other challenges of the lockdown.’

Those challenges are unfortunately already familiar in Nepal: lack of transportation to health facilities, a shortage of personal protective equipment (PPE), lack of gloves and other equipment for managing childbirth, and poor readiness of health facilities, etc.

The Lancet study did report witnessing some improved practices, such as more skin-to-skin contact between mothers and newborns and better hand-washing. It suggests a ‘need to continue communication with policy makers and programme coordinators to address such inequalities and coverage gaps so that additional deaths can be averted’.

In an interview earlier this year Baqi noted, “It’s good to have the ministry of health at the federal level saying, ‘Of course essential services must continue’ but there’s a big gap in implementation.”

On Friday she added via email: ‘While current attention is on preventing and treating COVID-19 cases, it is likely that maternal and newborn mortality has increased across the country due to poor utilisation of services on the one hand and lack of preparedness on the other hand.’

Baqi also pointed to shortages of trained personnel — including skilled birth attendants — essential life-saving drugs and PPEs. “The above concerns have received inadequate attention, among competing priorities, and limited financial resources have been mobilised to bridge the gaps in reproductive, maternal, child and adolescent health,” she said.

The Lancet Global Health paper concludes: ‘Pandemic lockdowns threaten lives and jeopardise progress that has been made in the past two decades in Nepal, potentially derailing on-track efforts to achieve the Sustainable Development Goals by 2030, especially for maternal and neonatal survival.’