COVID-19 Disruption and Maternal and Child Health Services: Evidence from India.

Objectives: To analyze the impact of COVID-19 and subsequent lockdowns on maternal and child health services in India and investigate whether certain population groups that are disadvantaged along social, economic and geographical dimensions experienced differential impacts.

Methods: Utilizing an unintended disruption in the fifth round of the National Family Health Survey (NFHS V) due to nationwide COVID-19 related lockdown, we create a sample of children and mothers who were 'exposed' to COVID-19 pandemic and lockdowns, and those who were not 'exposed'. We use multivariable regression to examine whether and to what extent antenatal care, pregnancy and post-pregnancy care of the 'exposed' mothers and children were adversely impacted as compared to those who were 'unexposed'.

Results: The 'exposed' mothers were less likely to receive two tetanus injections, and iron folic acid tablets during pregnancy, and were less likely to stay in medical facility for 48 hours post-delivery as recommended by the government guidelines. More critically, 'exposed' children had lower probability of receiving immunizations due at birth, 6-weeks, 10-weeks, and 14-weeks, with the magnitude of decline increasing for successive immunizations. The impacts were even more adverse in rural areas as reflected in heterogeneity analysis.

Conclusions: COVID-19 pandemic and lockdowns adversely affected MCH services in India, and even more so in rural India. Policy interventions targeted specifically at groups who were impacted would be needed to restore MCH services to pre-pandemic levels.

Clinical trial registration: Not Applicable.