Abstract

Intrapartum and postpartum care are essential to the health and well-being of mothers, infants, and families. In the wake of the COVID-19 pandemic, resources have shifted away from providing preventative services for mothers and newborns. This study seeks to determine how COVID-19 has influenced women’s pregnancy and postpartum care, including where women want to get care, newborn immunization rates and newborn care, and identify effective public service delivery strategies during the pandemic. Results from this study will produce timely information to be shared directly with the Ministry of Health to inform public service delivery to pregnant and postpartum women.

Policy Issue

Healthcare during and after childbirth is essential to the health and well-being of mothers, infants, and families. In the wake of the COVID-19 pandemic, healthcare systems worldwide face unprecedented challenges, with resources being shifted away from preventative services for mothers and newborns. COVID-19 has resulted in increased gender-based violence and decreased facility deliveries, child immunizations, and health care visits, potentially leading to adverse maternal and newborn health outcomes. Surveillance of pregnant and post-partum women is needed to identify effective and innovative modes of service delivery.

Little data exists on the effects of COVID-19 among pregnant and postpartum women and newborns. Evidence suggests that healthcare disruptions and decreased access to food may lead to increased maternal and child deaths. COVID-19 infections have caused severe maternal morbidity and perinatal deaths among pregnant women. Evidence from other crises and emerging infectious diseases--such as the influenza virus, Zika virus, and Ebola—associates them with decreased utilization of antenatal care, fewer facility deliveries, and increased risk of complications for pregnant women and infants. It is critical to understand the extent to which COVID-19 has similar impacts to develop appropriate mitigation strategies can be developed and implemented.

Context of the Evaluation

The Government of Kenya has made concerted efforts to improve maternal, neonatal, and child health, including by providing free maternity services since 2013. Although the country has made substantial improvements over the last two decades, the maternal mortality ratio in Kenya remains high at 342 deaths per 100,000 live births. Kenya's neonatal mortality rate of 21 deaths per 1,000 live births remains above the target of 12 per 1,000 by 2030, as outlined in the United Nations Sustainable Development Goals.

COVID-19 has produced unique challenges for maternal, neonatal and child health services, including interruptions in care and decreases in health utilization. Kenya has one of the highest rates of confirmed cases of COVID-19 among African countries. The pandemic threatens to disrupt healthcare utilization and delivery in the country, potentially reversing positive trends in these key population health indicators.

Details of the Intervention

This mixed-methods study uses a natural experiment to follow-up on an existing cohort of approximately 1,200 postpartum women and healthcare workers who were previously interviewed. These women visited a public or low-cost private health facility for intrapartum care. During the follow-up phone survey, researchers will collect post-partum or newborn data to examine how COVID has impacted their healthcare seeking behaviors.

Additionally, the study will recruit a new sample of 1,300 postpartum women for surveys and qualitative interviews to understand their pregnancy and early postpartum experience during COVID. The women in the new cohort delivered after government lockdown orders went into effect in March 16, 2020.

Researchers will also conduct 30 in-depth phone interviews with a subset of postpartum women who had a home delivery during Kenya’s lockdown period. Finally, researchers will re-contact healthcare providers that were previously interviewed in another study.

Results from this study will produce timely information for the Ministry of Health to inform public service delivery to pregnant and post-partum women. Specifically, this project will inform the development of a Community Advisory for pregnant and post-partum women on how to care for themselves and their newborns in the context of COVID-19. It will also facilitate the development of a Practice Advisory for optimizing obstetric, postpartum, and newborn care in the context of COVID—19 for local health facilities and community health workers.

Results and Policy Lessons

Evaluation underway; results forthcoming