Declines in essential health care utilization during the COVID-19 pandemic in low- and lower-middle-income countries devastatingly impact women and children's health, according to a new study published August 30 in the open-access journal PLOS Medicine by Tashrik Ahmed of the World Bank, US, and colleagues. In some of the world's poorest countries, the projected corresponding increases in child and maternal mortality can erase years of progress and cause thousands of preventable deaths.

Pandemics can affect health service utilization through numerous pathways. These include limitations in infrastructure, health workforce and supply chains, as well as altered patient behavior that can be attributed to changes in public transportation, mobility restrictions and fear of contracting illness. Early studies of the COVID-19 pandemic predicted that these service disruptions presented a threat to delivery of non-COVID healthcare services.

In the new study, researchers used data on service utilization from 18 countries in Africa and the Middle East to estimate the percent change in health services delivered between March 2020 and June 2021, compared to pre-pandemic levels. Across the countries, they found an average decline in outpatient consultation of 13.1%, and average declines of 2.6% to 4.6% for maternal and child services. The largest service disruptions occurred at the pandemic's start and during months with strict mobility restrictions. Using a mathematical model, the group projected corresponding increases of 3.6% in child mortality and 1.5% in maternal mortality.

"This work demonstrates how the COVID-19 pandemic has reversed years of progress in the health of women and children, especially those in the most vulnerable communities," says Dr. Ahmed. "As countries tackle multiple crises that continue to restrict service delivery and utilization, these findings can help them promote effective policies to strengthen health systems and recover with greater resilience."