Covid-19 has stretched threadbare health facilities in many parts of the world, often forcing the most difficult of choices – refusing medical care to one person to make room for another.
In Nepal, decades of progress in maternal and newborn health is now in jeopardy, according to new research published in the Lancet. The study, which looked at nine hospitals, found the number of births in these facilities fell by more than half during Nepal’s four-month lockdown to contain the spread of Covid-19. The rate of neonatal deaths more than tripled, from 13 to 40 per 1,000 live births. Still births and pre-term births also increased. Disadvantaged ethnic groups, such as Madhesis, suffered greater declines in access to clinical services.
“Services for women were shut down [during the lockdown] and those doctors were moved to serve Covid patients,” explained Dr Lhamo Sherpa, an epidemiologist and medical doctor, adding that women were “sent away by the hospitals, saying ‘we do not want to take in cases.’”
The lockdown was aimed at providing authorities time to bolster the capacity of health care facilities. But the government response was poor, and the number of Covid-19 cases has been increasing since the start of June, with reports of community transmission in the crowded Kathmandu Valley.
Since 2000 Nepal has made significant gains in the number of women giving birth in clinics and hospitals, contributing to major decreases in maternal and neonatal mortality. Between 2000-2019, the number of institutional births more than quadrupled, while maternal mortality declined by 76 percent, and newborn mortality declined by 62 percent.
The study’s authors fear a reversal for women’s health and infant mortality. “The COVID-19 outbreak and response has reduced coverage of health facility births and widened inequalities in Nepal, with significantly increased institutional stillbirth and neonatal mortality rates,” they conclude, warning that there could be a similar decline in other low-income and middle-income countries.
The Nepal government should respond urgently to the study with steps to get back on the path toward reducing maternal and infant mortality. Other countries should take notice of the Lancet research and make it a priority to protect access to sexual and reproductive health services throughout the pandemic.