Effect of the COVID-19 pandemic on maternal healthcare indices in Southern Iran: an interrupted time series analysis

OBJECTIVES: Epidemics are anticipated to influence the coverage of health services. We assessed the impact of the COVID-19 pandemic on maternal healthcare indices and care providers’ performance. SETTING: 1801 maternal healthcare centres under the auspices of Shiraz University of Medical Sciences, Shiraz, Southern Iran. PARTICIPANTS: Approximately 63 000 pregnant women. PRIMARY AND SECONDARY OUTCOME MEASURES: In this prospective ecological study, interrupted time series analysis was used to model and compare the trend of maternal healthcare indices before and after the COVID-19 pandemic announcement. RESULTS: The results showed a significant drop in count of preconception healthcare visits, first routine laboratory tests, first trimester prenatal care, first trimester sonography, prenatal screening for birth defects at weeks 11–13, prenatal care visits at weeks 16–20, second routine laboratory tests, second trimester sonography, prenatal care visits at weeks 24–30, prenatal care visits at weeks 31–34, postpartum care visits at days 10–15 and postpartum care visits at days 30–42 with the start of the COVID-19 pandemic (−50% (95% CI −48.68% to –51.36%), −19.67% (95% CI −22.12% to –17.15%), −25.88% (95% CI −28.46% to –23.21%), −23.84% (95% CI −26.26% to –21.34%), −20.16% (95% CI −23.01% to –17.20%), −18.53% (95% CI −21.25% to –15.71%), −28.63% (95% CI −31.03% to –26.14%), −27.48% (95% CI −30.07% to –24.79%), −31.08% (95% CI −33.43% to –28.61%), −31.84% (95% CI −34.35% to –29.23%), 32.55% (95% CI −35.12% to –29.89%) and −39.28% (95% CI −41.59% to –36.88%), respectively). Nevertheless, the trend in coverage of these services showed recovery in the subsequent months (8.36%, 10.55%, 5.74%, 8.01%, 4.40%, 5.06%, 11.20%, 7.58%, 7.38%, 7.80%, 9.59% and 9.61% per month, respectively). CONCLUSIONS: Using ecological data during the COVID-19 pandemic era, we observed a ‘level change and slope change’ as the major pattern of interruption of maternal healthcare coverage, indicating a possible indirect effect rather than a causative relationship. Such relative predictability might assist with future pandemic planning.