# From pandemic to progress: maternal health resilience in the post COVID-19 era in Tamil Nadu, India

## TL;DR

The study shows that maternal and newborn health outcomes in Tamil Nadu improved after pandemic-era investments in emergency medical services.

## Contribution

The study demonstrates that pandemic-era interventions significantly improved maternal and neonatal health outcomes in Tamil Nadu.

## Key findings

- Maternal mortality in Tamil Nadu dropped to 37 deaths per 100,000 live births in 2023-24, much lower than the national average.
- Government investments during the pandemic led to improved EMS metrics and better maternal-newborn outcomes.
- Rates of home births, miscarriages, and neonatal deaths decreased significantly in the post-pandemic resilient phase.

## Abstract

In India, like most countries, the COVID-19 pandemic in successive waves severely hampered the emergency medical services (EMS) and the government made prompt interventions, including substantial investments in both EMS and maternal health care immediately after the first wave. The study assessed variations in EMS efficiency and critical perinatal outcomes between the pre-pandemic era and the post pandemic-resilient phase in 2023 and 2024.

The study analysed the key EMS metrics based on the calls related to pregnancy, including call volume, response and transfer time, hospital handoff time and ambulance travel distance, and important maternal-newborn health outcomes such as maternal and neonatal mortalities, home deliveries, institutional childbirths, C-section deliveries, miscarriages and complicated vaginal births. The data relied upon encompasses the period from January 2017 to December 2024, including eight pandemic phases in 2020-22 and the resilient period of 2023 and 2024, obtained from the Tamil Nadu 108 Ambulance Control Room. A time series analysis method evaluated the EMS metrics in various pandemic phases; a statistical comparison was made with the pre-pandemic period for maternal-newborn outcomes. The appropriate effect size metric quantified the change in both analyses.

In the pandemic phases, despite an increase in pregnancy related call volume, the EMS metrics such as response times, transfer times and hospital handoff times witnessed notable improvement. The maternal and childbirth outcomes, especially in the post-pandemic and resilient phases during 2023-24, were markedly superior when compared with the corresponding period in the pre-pandemic era. In particular, the maternal mortality rate reduced by 19%, with 37 deaths per 100,000 live births. This is far lower than the national average of 97 deaths per 100,000 live births. Also, the rates of infant death, neonatal death, miscarriage, difficult vaginal births, and home births went down by 19.35%, 17.03%, 28.02%, 19.23%, and 36.05%, respectively.

Government investments during the pandemic, along with the sustained focus on maternal health programmes, appear to have provided substantial support to pregnant women and newborns. The reproductive health of women in Tamil Nadu does not seem to have been undermined by the pandemic.