What is the impact of COVID-19 pandemic years on Deliveries and Home Based New Born Care in India? A cross-sectional comparative research study, Jan 2018-2021Dec

The COVID-19 pandemic caused by SARS-CoV-2 has led to disruption of health services globally. I assessed the effect of the ongoing pandemic on the Deliveries and Home Based New Born Care (HBNC) in India. The author is curious and suspects a rise in maternal and neonatal mortality due to possible negative effects of COVID-19 on maternal institutional delivery and HBNC. Hence author decided to �nd out answer to the research question mentioned as title above. I conducted a retrospective cross-sectional comparative study among total numbers of women and newborn who have received delivery and HBNC care at different health facilities in 36 states and union territories across India during the pandemic years with pre-pandemic years (comparing 2020 and 2021(forecasted up to December 2021 with available data from January2021 to May 2021) with previous two years of pre-pandemic era i.e. 2018-2019). The data for the research study is extracted from electronic records of HMIS (health management information system) of MoHFW (ministry of health and family welfare), Govt. of India and analysed with stata and Microsoft o�ce. This research study revealed that during covid-19 era there is increase in prevalence of 1.Total No. of Deliveries-TD (HD+ ID) registered per 100000 ANC registered,2.Total Number of Institutional Deliveries (ID) conducted (Including C-Sections) per 100000 Total deliveries3.Total Number of Home Deliveries attended by SBA per 100000 HD4.Total Number of newborns received 6 HBNC visits after Institutional Delivery per 100000 ID5.Total Number of newborns received 7 HBNC in HD per 100000 HD5.Total Number of PW given Tablet Misoprostol during HD per 100000 HD. This research study revealed that pandemic years have less number of home deliveries attended by SBA [(Skill Birth Attendant) (Doctor/Nurse/ANM/ Midwife)] as well as there is also decrease in HD. This research study revealed that pandemic years have less number of home deliveries attended by SBA [(Skill Birth Attendant) (Doctor/Nurse/ANM/ Midwife)] may be due to less number of deliveries. There is a (projected) decrease of 37.28% in mean number of home deliveries attended by SBA in 2021 as compared to 2018. This novel research study revealed that during pandemic years 2020 and 2021 all the variables reduced quantitatively except Number of PW given Tablet Misoprostol during HD which increased in 2020 (�rst pandemic year).The ongoing COVID-19 pandemic has had negative effects on Deliveries and Home Based New Born Care (HBNC) in India. More research is required to investigate the direct and indirect consequence of the pandemic on birth and provision of HBNC as well as the health facility type which are not performing well in providing respectful maternity care and newborn services during pandemic period. The facility based research analysis is under process by the author which will be available in next version of this article.


Introduction Background/Rationale
As per the previous estimates of UNICEF (United Nations International Children's Emergency Fund) about 116 million babies will be born within 40 weeks of ongoing COVID-19 pandemic, straining health systems as well as medical supply chains globally -was declared as a pandemic on March 11 [1].Pregnant mothers as well as babies born during the ongoing COVID-19 pandemic are continued to be threatened by strained health systems involved in ghting with this novel disease.I assessed the effect of the ongoing pandemic on the Deliveries and Home Based New Born Care (HBNC) in India.The author is curious and suspects a rise in maternal and neonatal mortality due to possible negative effects of COVID-19 on maternal institutional delivery and HBNC.Hence author decided to nd out answer to the research question mentioned as title above.Global containment measures like lockdowns etc; health centres overwhelmed with covid-19 response efforts added with supply and equipment shortages and a lack of su cient skilled birth attendants because health workers, including midwives, are redeployed to treat COVID-19 patients [1].During this ongoing pandemic years countries expected with highest numbers of births during the 9 months since the declaration of pandemic are 1.India (20.1 million) 2.China (13.5 million), 3.Nigeria (6.4 million), 4.Pakistan (5 million) and 5.Indonesia (4 million).As per available data most of these countries listed above had a high neonatal mortality rates (NMR) even before the covid-19 pandemic and these levels may increase with COVID-19 situations [1].Every year 25 million children are born in India accounting for one fth of the global child births and every minute one baby dies.It is a fact that 46 per cent of all maternal mortality and 40 per cent of neonatal mortality happen during labour or in the rst 24 hours after birth [2].This research study is signi cant as death can be reduced by provision of good delivery care at institution/health facilities by enabling access to SBA (skilled birth attendants) and EMOC (emergency obstetric care) services.Home based newborn care (HBNC) in the post-new-born period can improve survival rates with early and exclusive breastfeeding and immunizing newborn against vaccine preventable diseases.

Objective
The key aim of this research study was to nd out the impact of COVID-19 pandemic years on Deliveries and Home Based New Born Care in India.To ful l the aim of study the objective was to collect, analyse, interpret the data for the research question.

Study Design
The researcher conducted a retrospective cross-sectional comparative study among total numbers of women and newborn who have received delivery and HBNC care in different ways at different health facilities in 36 states and union territories across India during the pandemic (comparing 2020 and 2021(forecasted up to December 2021 with available data from January2021 to May 2021) with previous two years of pre-pandemic era i.e. 2018-2019).

Setting
Location -All India across 36 states and union territories.).This will also show the trends of delivery and HBNC in the study period.There is a declining trend in No. of pregnant women registered for ANC-Taken as total number of pregnancy during pandemic years 2020 and 2021 as compared to pre-pandemic years.A similar trend was observed in all other variables in this research study except in 2020 1. Number of PW given Tablet Misoprostol during HD increased in number compared to previous year 2019 by 4306 and 5.78639 percent (%) 2. number of newborns received 6 HBNC visits after Institutional Delivery HD increased in number compared to previous year 2019 by 669946 numbers and 8.393705 percent (%).The mean number of women discharged within 48 hours of delivery out of total ID during the pandemic year 2021 with total number of observation of 5 months forecasted up to December 2021across India was 448537.5, for years 2020, 2019, 2018 it was 540251.83,574242.75, and 566933.5 respectively with total number of observation of 12 months across India for these three years.This research study revealed that pandemic years have less number of women discharged within 48 hours of delivery out of total ID.There is a of 12.32 % in number of women discharged within 48 hours of delivery out of total ID in 2021 as compared to 2018.
The mean number of newborns received 6 HBNC visits after Institutional Delivery during the pandemic year 2021 with total number of observation of 5 months forecasted up to December 2021across India was 696260.9, for years 2020, 2019, 2018 it was 720956.25,665127.42,and 533751.08respectively with total number of observation of 12 months across India for these three years.This research study revealed that pandemic years have less number of newborns received 6 HBNC visits after Institutional Delivery.There is an increase of 40.03 % in mean number of newborns received 6 HBNC visits after Institutional Delivery in 2021 as compared to 2018.

Study Strength and Limitation
This is a novel cross-sectional retrospective research study based on accredited secondary data which was one of the limitations of this research study.Another limitation is data availability is not for latest time and date, hence it is forecasted using standard statistical method using excel.Accredited and established source of data recognized worldwide is not available for the same study anywhere else.The main strength is that the whole study is on real time based accredited government data and this of research study is unique and not available for the context India or other countries as found by the researcher of this novel study.

Conclusion And Recommendation
The ongoing COVID-19 pandemic has had less number of Deliveries and hence less Home Based New Born Care (HBNC) in India.More research is required to investigate the direct and indirect consequence of the pandemic on birth and provision of HBNC as well as the health facility type which are not performing well in providing respectful maternity care and newborn services during pandemic period.The facility based research analysis is under process by the author which will be available in next version of this article.The author recommends following: Establishment of exclusive specialised birth centres as pregnant women feels usually worried about giving birth in multipurpose hospitals.
Helping pregnant women to receive ANC checkups, delivery care, postnatal care, COVID-19 care as needed; Ensuring availability of skilled health workers with PPE (personal protective equipment), priority testing and vaccination so that they can deliver care to all pregnant women and newborn babies without spreading -Funding-Self sponsored.No aid taken from individual or agency etc. -

Figures Figure 1
Figures

Table - 2
-Eligibility criteria or criteria for inclusion

Table - 3
-Total and Mean of Pregnancy and Delivery

Table - 5
-Increase and decrease in numbers and percentage of different variables taking 2018 base year variables reduced quantitatively except 1.Number of PW given Tablet Misoprostol during HD 2. Number of newborns received 6 HBNC visits after Institutional Delivery 3.Total HD 4. Home Deliveries attended by Non SBA which increased little in 2020 see-table 5 and gure 1 ( rst pandemic year).The statistical analysis of observation for years 2021, 2020, 2019 and 2018 is given in table-6, 7, 8, and 9 and data for each year is given in 10, 11, 12, and 13.

Table - 6
-Summary-statistics-2021 (Jan to Dec) Table -6-Summary-statistics-2021 (Jan to Dec) The mean number of home deliveries attended by SBA [(Skill Birth Attendant) (Doctor/Nurse/ANM/ Midwife)] during the pandemic year 2021 with total number of observation of 5 months forecasted up to December 2021across India was 13370.28,for years 2020, 2019, 2018 it was 16429.25,19006.58,21317.83respectively with total number of observation of 12 months across India for these three years.

Table - 7
-Summary-statistics-2020 (Jan to Dec)This research study revealed that pandemic years have less number of home deliveries attended by SBA [(Skill Birth Attendant) (Doctor/Nurse/ANM/ Midwife)].There is a decrease of 37.28% in mean number of home deliveries attended by SBA in 2021 as compared to 2018.The details of data and statistical analysis are mentioned in table-6, 7, 8, 9, 10, 11, 12, 13, 14 and the comparisons of various indicators are displayed in gures 1.The mean number of Number of Home Deliveries attended by Non SBA (Trained Birth Attendant (TBA) /Relatives/etc.during the pandemic year 2021 with total number of observation of 5 months forecasted up to December 2021across India was 53901.39,for years 2020, 2019, 2018 it was 73351.66,84592.58,99830.25 respectively with total number of observation of 12 months across India for these three years.This research study revealed that pandemic years have less number of home deliveries attended by Non SBA (Trained Birth Attendant (TBA) /Relatives/etc.There is a decrease of 33.74 % in mean number of home deliveries attended by Non-SBA in 2021 as compared to 2018.There is a decrease of 9.72 % in mean Number of PW given Tablet Misoprostol during home delivery in 2021 as compared to 2018.
The mean number of Number of PW given Tablet Misoprostol during home delivery during the pandemic year 2021 with total number of observation of 5 months forecasted up to December 2021across India was 5318.511, for years 2020, 2019, 2018 it was 6560.16,6201.33, and 6718.42 respectively with total number of observation of 12 months across India for these three years.This research study revealed that pandemic years have less number of PW given Tablet Misoprostol during home delivery.
months across India for these three years.This research study revealed that pandemic years have less number of Institutional Deliveries conducted (Including C-Sections).There is a decrease of 8.34 % in mean number of Institutional Deliveries conducted (Including C-Sections) in 2021 as compared to 2018.
due less number of pregnancy and resultant deliveries during covid-19era.The prevalence rate discussed at end will clear the scenario.The mean number of Institutional Deliveries (ID) conducted (Including C-Sections)during the pandemic year 2021 with total number of observation of 5 months forecasted up to December 2021across India was 1338094, for years 2020, 2019, 2018 it was 1608193.92,1694021.12,and 1615700.92respectively with total number of observation of 12

Table - 9
-Summary-statistics-2018 (Jan to Dec) Table-10-Prevalence of different study variables per 100000 in different yearsUrgent attention and measures should be taken by government and policy makers to continue to provide maternal and newborn health services during ongoing COVID-19 pandemic.Government, policy makers should develop special need based guidelines, interventions-for the pregnant women and newborn.Continuous monitoring and routinely checking -the existing facilities health service in different levels of hospitals i.e. from local to tertiary specialised and rural-urban-public-private clinics.Legal regulations and strict enforcements so that healthcare institutions cannot deny providing maternal and newborn services.Training and capacity building of the health workers including everyone and to sort out the barriers to access maternal-newborn health services during ongoing COVID-19.Raising awareness among PW and relatives about visiting health care facilities along with the positive behavioural change of the health workers to work in pandemic situations can help in mitigation of negative impacts of covid-19. Discussion Authors' contributions: The whole work is done by the Author -Dr Piyush Kumar, M.B.B.S., E.M.O.C., P.G.D.P.H.M., -Senior General Medical O cer-Bihar Health Services-Health Department-Government of Bihar, India.-Acknowledgements-Iamthankful to Advocate Anupama my wife and daughters Aathmika-Atheeva for cooperation.This article is available only as pre-print and not published by any peer-reviewed journals.authorhaswritten previously on this research which is available as preprint.There are chances of text and data overlapping with author previous works available as preprints only mentioned above in the references[5, 6, 7, 8,  and 9, 10]-Author information: The author is currently working as Senior General Medical O cer for the government of Bihar.