Reproductive Health Crisis During Waves One and Two of the COVID-19 Pandemic in India: Incidence and Deaths From Severe Maternal Complications in More than 202000 Hospital Births

Background: The 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. Methods: Hospital-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. Results: There 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. Conclusion: Our 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. Funding Information: The MaatHRI platform and this study was funded by a Medical Research Council Career Development Award to MN (Ref:MR/P022030/1). Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: The MaatHRI platform and the repeated monthly survey have been approved by the institutional review boards (IRB) of each coordinating Indian institution, namely: Srimanta Sankaradeva University of Health Sciences, Guwahati, Assam (No.MC/190/2007/Pt-1/126); Nazareth hospital, Shillong, Meghalaya (Ref No. NH/CMO/IEC/COMMUNICATIONS/18-01); Emmanuel Hospital Association, New Delhi (Ref. Protocol No.167); Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra (Ref No. MGIMS/IEC/OBGY/118/2017); and the Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh (No.Dean/2018/EC/290). The project has also been approved by the Government of India’s Health Ministry’s Screening Committee, the Indian Council of Medical Research, New Delhi (ID number 2018-0152) and by the Oxford Tropical Research Ethics Committee (OxTREC), University of Oxford, UK (OxTREC Ref: 7-18).