Impact of the early stages of the COVID-19 pandemic on coverage of RMNH interventions in Ethiopia

Background

The COVID-19 pandemic and response have the potential to disrupt access and use of reproductive, maternal, and newborn health (RMNH) services. Numerous initiatives aim to gauge the indirect impact of COVID-19 on RMNH.

Methods

We assessed the impact of COVID-19 on RMNH coverage in the early stages of the pandemic using panel survey data from PMA-Ethiopia. Enrolled pregnant women were surveyed 6-weeks post-birth. We compared the odds of service receipt, coverage of RMNCH service indicators, and health outcomes within the cohort of women who gave birth prior to the pandemic and the COVID-19 affected cohort. We calculated impacts nationally and by urbanicity.

Results

This dataset shows little disruption of RMNH services in Ethiopia in the initial months of the pandemic. There were no significant reductions in women seeking health services or the content of services they received for either preventative or curative interventions. In rural areas, a greater proportion of women in the COVID-19 affected cohort sought care for peripartum complications, ANC, PNC, and care for sick newborns. Significant reductions in coverage of BCG vaccination and chlorohexidine use in urban areas were observed in the COVID-19 affected cohort. An increased proportion of women in Addis Ababa reported postpartum family planning in the COVID-19 affected cohort. Despite the lack of evidence of reduced health services, the data suggest increased stillbirths in the COVID-19 affected cohort.

Discussion

The government of Ethiopia’s response to control the COVID-19 pandemic and ensure continuity of essential health services appears to have successfully averted most negative impacts on maternal and neonatal care. This analysis cannot address the later effects of the pandemic and may not capture more acute or geographically isolated reductions in coverage. Continued efforts are needed to ensure that essential health services are maintained and even strengthened to prevent indirect loss of life.

What is already known?

• COVID-19 pandemic and response have the potential to disrupt access and use of reproductive, maternal, and neonatal health services

• Anecdotal evidence suggests some disruptions to health system staffing and resources, service access, and health campaigns in Ethiopia early in the pandemic

What are the new findings?

• Our analysis of PMA-Ethiopia panel survey data shows little disruption of RMNH services in Ethiopia in the initial months of the pandemic

• Compared to immediately prior to the pandemic we observed an increase in care-seeking in rural areas, commodity-related intervention reductions in urban areas, and an increase in postpartum family planning in Addis Ababa

• Despite the lack of evidence of a reduction in health services, the data suggest increased stillbirths in the COVID-19 affected cohort

What do the new findings imply?

• The government of Ethiopia successfully maintained continuity of most RMNCH services during the early stages of the COVID-19 pandemic

• Continued efforts are needed to ensure that essential health services are maintained and even strengthened to prevent indirect loss of life