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| EDITORIAL |
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| Year : 2020 | Volume
: 7
| Issue : 4 | Page : 163-165 |
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The impact of COVID-19 pandemic on reproductive health care for women
Sushil Kumar
Editor-in-Chief, MGM Journal of Medical Sciences (MGMJMS), Department of Obstetrics and Gynecology, MGM Medical College and Hospital, MGM Institute of Health Sciences (Deemed to be University), Navi Mumbai, Maharashtra, India
| Date of Submission | 14-Oct-2020 |
| Date of Acceptance | 14-Oct-2020 |
| Date of Web Publication | 09-Dec-2020 |
Correspondence Address:
Dr. Sushil Kumar
Department of Obstetrics and Gynecology, MGM Medical College and Hospital, MGM Institute of Health Sciences (Deemed to be University), Navi Mumbai 410209, Maharashtra.
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/mgmj.mgmj_86_20
How to cite this article:
Kumar S. The impact of COVID-19 pandemic on reproductive health care for women. MGM J Med Sci 2020;7:163-5 |
The COVID-19 pandemic has impacted every aspect of human life. Worldwide, more than 2.8 crore (28 million) people have been infected by COVID-19 by early September 2020 and the tally is still going up. The number of cases in India has risen from 470 in early March to more than 5 million on September 2020. Despite lockdown, there has been an exponential increase in the incidence of COVID-19. We cannot even guess “when it is going to end?” In this scenario, the patients advised elective surgery or an invasive procedure have to wait endlessly, leading to stress and depression. Women suffer more due to lack of contraceptive and medical termination of pregnancy services, absence of antenatal care during pregnancy, and an embargo on assisted reproductive technology (ART).
| EFFECT ON FERTILITY/INFERTILITY SERVICES | |  |
There is no doubt that COVID-19 has affected all the reproductive health care services adversely. In this particular issue of the MGM Journal of Health Sciences (MGMJMS), Dr. Mini Paul et al. have given their perspective on COVID-19 and its effect on patients undergoing infertility treatment. The article highlights the need of performing part of ART (assisted reproductive technology) procedures during COVID lockdown time. The author feels that these procedures may be classified as emergency procedures and may be taken up on priority. The authors especially emphasized emergency treatment for those who have a low ovarian reserve or the patient waiting for cancer treatment but wants to retain fertility. They recommend that in such patients the ovum be harvested, fertilized, and frozen. Frozen embryo transfer (FET) could be undertaken at a later date when the COVID-19 pandemic situation improves; FET has a good success rate and could be preserved for a long time.
The idea is noble but it will help very few patients. Also, there would be some chance of the patient or attending medical staff getting infected with COVID-19. Finally, there could be small chances of litigation from the patients if they get infected since there are no clear-cut guidelines to restart routine infertility services. International professional bodies such as the American Society of Reproductive Medicine (ASRM)[1] and the European Society for Human Reproduction and Embryology (ESHRE)[2] are yet to recommend the commencement of infertility treatment at pre-COVID levels. However, the number of cases with coronavirus infections are still rising in India and more so in Mumbai. The number of fresh cases is a thousand times more in September 2020 than it was in March 2020, when both ASRM and ESHRE recommended the stoppage of ART procedures. Therefore, in my opinion, it would be prudent to wait for the decline in fresh cases before undertaking ART procedures.
Disruption of contraceptive and abortion services during COVID lockdown may lead to population explosion
The world over, about 50% of pregnancies are either unwanted or unintended. In developing countries, unwanted pregnancies may have serious consequences, such as “unsafe abortion” leading to maternal morbidity or mortality.[3] At the moment (from March 2020 to September 2020), the situation is much worse due to the countrywide closure of safe abortion services. There are published and unpublished reports that are suggestive of population explosion attributable to the COVID-19 situation in India.
“COVID-19 lockdown may derail India’s population control measures” are the headlines of a very timely article published in “WEEK” magazine in May this year.[4] The author felt that the absence of family planning services during the lockdown period may lead to a higher population growth trajectory for India. Surgical procedures such as medical termination of pregnancy and permanent family planning methods such as tubal sterilization for women and vasectomy for men are not being taken up due to fear of COVID-19 infection to the staff and the patients. Also, most of the hospitals are overburdened by the patients with COVID, and they have no staff and beds to undertake life-saving procedures. It has been estimated that lockdown will hurt family planning services; it may result in about 25 million couples not being able to procure contraceptives in India. The year 2020 may see 693,290 less sterilizations, 975,117 fewer intra-uterine contraceptive devices (IUCDs), 23 million fewer cycles of oral contraceptive pills, and 926,871 less postcoital emergency contraceptive pills.[4] It is a general perception that most of the welfare schemes are not successful in India, because a huge population dilutes its effect by the time it reaches the common man. Therefore, for a country such as India further addition of population due to lack of contraception services during lockdown will become a huge responsibility. State or central governments must issue clear instructions that non-COVID hospitals must provide for contraceptive and abortion services.
| PREGNANCY IN PATIENTS POSITIVE FOR COVID-19 | | |
It has been observed that the effect of COVID-19 on pregnant women is no different than in nonpregnant patients. However, COVID-19 did change the practice of obstetrics to some extent. Once again, the “art of asepsis and anti-sepsis” is being practiced meticulously as modern medicine is not helping us in our fight against COVID-19. Most of the patients who are positive for COVID-19 generally have mild symptoms such as fever, cough, fatigue, shortness of breath, headache, and diarrhea and they recover from it within 3–5 days.[5] The involvement of the vital organs, especially the lungs, places them in the high-risk category. Whenever we consider infection in a pregnant lady, we do consider infection in the fetus and neonate too. So far, there has been no evidence of vertical transmission of infection from mother to the baby in utero.[6] Small studies have not shown the presence of the virus in amniotic fluid or breast milk.[7] Most of the infections in the neonate are acquired after birth. Therefore, the baby has to be separated from the mother and fed on the expressed breast milk of the mother until she becomes COVID negative.
MGM Medical College and Hospital, Navi-Mumbai, India was officially declared as a COVID-19 center in March 20. Since then, we have been managing patients who are COVID-19 positive as per guidelines. A total of forty-two patients who were COVID positive were delivered in the hospital from March to September 2020. We did not find an increase in complications rate in the patients who did not have pulmonary involvement. However, one of the patients who had extensive lung involvement died four days after the cesarean section due to multiorgan failure. The incidence of emergency cesarean section was higher in patients who were COVID-19 positive. Most of the cesarean sections in patients who were COVID-19 positive were done for fetal distress.
The COVID-19 pandemic and the lockdown imposed by administrative authorities, though necessary to control the outbreak, has also led to restriction of movements of pregnant women, thus reducing their access to antenatal care. We have seen a sudden spurt in the incidence of “high-risk obstetrics” during the COVID-19 lockdown period. The fear of COVID-19 infection has also led to the closure of many private and governmental health-care facilities, increasing the workload on tertiary care centers. During this period, there has been a 35.5% increase in emergency admissions; as well as an increase in maternal mortality, intrauterine fetal death, and neonatal mortality. The cause of increased mortality could be delayed treatment due to the closure of primary and secondary health-care services.
To conclude, one of the greatest sufferers of the current COVID-19 pandemic is the women in the reproductive age group. The ART services have been closed, and contraceptive services are considered low priority. Access to health care for pregnant women has been reduced substantially. The patients in labor and their attendants lose precious time going from one hospital to another, thus increasing complications rates. It is time to start full-fledged contraceptive services with immediate effect. The ART treatment may be started after the stabilization of the current pandemic. The antenatal and maternity services in private or public sectors must be started at the earliest to avoid hardships and complications to pregnant women belonging to all sections of the society.
Financial support and sponsorship
MGMIHS.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | American Society of Reproductive Medicine(ASRM). Impacting Reproductive care worldwide. Patient Management and clinical Recommendations during the Coronavirus (COVID-19) Pandemic as of 17 March 2020. Available from: http// asrm org/global assets/asrm-content/news-and-publications/covid-19/covid task force.pdf. [Last accessed on 2020 September 10].  |
| 2. | Assisted reproduction and COVID-19: A statement from ESHER for phase 2. April 23, 2020. Available from: http://www.eshere.eu/Home/COVID19WG. [Last accessed on 2020 September 10]. |
| 3. | Nanda K, Lebetkin E, Steiner MJ, Yacobson I, Dorflinger LJ Contraception in the era of COVID-19. Glob Health Sci Pract 2020;8:166-8. |
| 4. | Thomas MP COVID-19 lockdown may derail India’s population control measures. May 21, 2020. Available from: https://www.theweek.in/news/health/2020/05/21/covid-19-lockdown-may-derail-india-population-control-measures.html. [Last accessed on 22 September 2020]. |
| 5. | López M, Gonce A, Meler E, Plaza A, Hernández S, Martinez-Portilla R, et al. Coronavirus disease 2019 in pregnancy: A clinical management protocol and considerations for practice. Fetal Diagn Ther 2020;47:519-28. |
| 6. | Yan J, Guo J, Fan C, Juan J, Juan J, Yu Xuechen, et al. Coronovirus disease 2019 in pregnant women: A report based on 116 cases. Am J Obstet Gynecol 2020;223:111.e1-14. |
| 7. | Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: A retrospective review of medical records. Lancet 2020;395:809-15. |
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