Global changes in maternity care provision during the COVID-19 pandemic: A systematic review and meta-analysis

Rosemary Townsend, Barbara Chmielewska, Imogen Barratt, Erkan Kalafat, Jan van der Meulen, Ipek Gurol-Urganci, Pat O'Brien, Edward Morris, Tim Draycott, Shakila Thangaratinam, Kirsty Le Doare, Shamez Ladhani, Peter von Dadelszen, Laura A. Magee, Asma Khalil*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)
8 Downloads (Pure)


Background: The COVID-19 pandemic has had a profound impact on healthcare systems globally, with a worrying increase in adverse maternal and foetal outcomes. We aimed to assess the changes in maternity healthcare provision and healthcare-seeking by pregnant women during the COVID-19 pandemic.

Methods: We performed a systematic review and meta-analysis of studies of the effects of the pandemic on provision of, access to and attendance at maternity services (CRD42020211753). We searched MEDLINE and Embase in accordance with PRISMA guidelines from January 1st, 2020 to April 17th 2021 for controlled observational studies and research letters reporting primary data comparing maternity healthcare-seeking and healthcare delivery during compared to before the COVID-19 pandemic. Case reports and series, systematic literature reviews, and pre-print studies were excluded. Meta-analysis was performed on comparable outcomes that were reported in two or more studies. Data were combined using random-effects meta-analysis, using risk ratios (RR) or incidence rate ratios (IRR) with 95% confidence intervals (CI).

Findings: Of 4743 citations identified, 56 were included in the systematic review, and 21 in the meta-analysis. We identified a significant decrease in the number of antenatal clinic visits (IRR 0614, 95% CI 0486–0776, P<00001, I2=54.6%) and unscheduled care visits (IRR 0741, 95% CI 0602–0911, P = 00046, I2=00%) per week, and an increase in virtual or remote antenatal care (IRR 4656 95% CI 7762–2794, P<00001, I2=90.6%) and hospitalisation of unscheduled attendees (RR 1214, 95% CI 1118–1319, P<00001, I2=00%). There was a decrease in the use of GA for category 1 Caesarean sections (CS) (RR 0529, 95% CI 0407–0690, P<00001, I2=00%). There was no significant change in intrapartum epidural use (P = 00896) or the use of GA for elective CS (P = 079)

Interpretation: Reduced maternity healthcare-seeking and healthcare provision during the COVID-19 pandemic has been global, and must be considered as potentially contributing to worsening of pregnancy outcomes observed during the pandemic.

Original languageEnglish
Article number100947
Publication statusPublished - 18 Jun 2021

Bibliographical note

Funding information: There was no funding received for this study. Therefore, no funder had any involvement in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Dr Morris reports grants and other from Gedeon Richter, grants and other from Chugai Pharma, personal fees from Pfizer, personal fees from Gedeon Richter, other from Kebomed, from null, outside the submitted work; and President and Trustee, RCOG Trustee, British Menopause Society Chair of Trustees, Group B Strep Support.

Open Access: This is an open access article under the CC BY-NC-ND license (

Publisher Copyright: © 2021 The Author(s). Published by Elsevier Ltd.

Citation: Townsend, Rosemary, et al. "Global changes in maternity care provision during the COVID-19 pandemic: A systematic review and meta-analysis." EClinicalMedicine 37 (2021): 100947.



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