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.

The preference of Iranian women to have normal vaginal or cesarean deliveries.

BACKGROUND: The cesarean section (C-section) has higher risk compared to normal vaginal delivery (NVD). The aim of this population-based study was to evaluate the frequency of mothers' tendency toward the mode of delivery and the factors that can affect this inclination. MATERIALS AND METHODS: This cross-sectional study was conducted from August 2011 to June 2012 in Fars Province, Iran, and comprised mothers in their 20(th) to 30(th) weeks of pregnancy. A questionnaire was designed to include, sociodemographic information, maternal knowledge, main sources of knowledge, attitude of the mother, husband, parents, close friends, and gynecologist, regarding the route of delivery, convenience factors, and barriers to choosing NVD, and mother's preference for the route of delivery. RESULTS: Of 6921 participants, 2197 (31.7%) preferred C-section and 4308 (62.2%) favored NVD while 416 (6%) had no idea regarding the preferred route of delivery. Score of knowledge in 904 (13.1%) participants was zero, and 1261 women (18.2%) achieved an acceptable level of knowledge. Using binary logistic regression, positive history of previous abortion and/or infertility, higher education level of mother and husband, mother's unacceptable level of knowledge regarding complications of C-section, and mother's and husband's positive attitude toward C-section were determinant factors in choosing C-section as a preferred route of delivery. CONCLUSION: Appropriate measures should be taken to raise awareness and knowledge of mothers and all families about complications of the C-section. Establishment of clinics for painless NVD and assuring mothers of benefits and lower complications of NVD can reduce the tendency for C-sections.