Impact of COVID-19 pandemic on safe abortion and family planning services at a tertiary care women’s hospital in Nepal

Background: The COVID-19pandemic emerged as a major public health crisis, which has affected all dimensions of the health care system. Sexual and reproductive health services were severely affected, leading to a decrease in access and service utilization, affecting the overall health of women.Methods: A two-year comparative study, before and during the COVID-19 pandemic, on safe abortion services and family planning, was conducted at Paropakar maternity and women's hospital to assess the impact of COVID-19 on service utilization.Results: Safe abortion services were decreased by 34.4%, and family planning services by 39%, in 2020 as compared to the previous year. Uptake of long-acting reversible contraceptives and permanent methods was most affected. Utilization of services was affected markedly during lockdown, and showed a persistent decline, even after the lockdown was lifted.Conclusions: The COVID-19 pandemic has seriously affected safe abortion and family planning services in Nepal due to lockdown, travel restriction, home isolation, resource reallocation, health facilities serving only emergencies and confusing messages about COVID-19 control. The decline in these services will create additional demand and pressure on the health care system, resulting from unplanned pregnancies and unsafe abortions. Health care staffs should be reoriented about the essential nature of safe abortion and family planning services during emergencies, and the implications of service disruption, on society and the country. Pragmatic and gender sensitive changes to national policies should be made, to ensure that women's health is safeguarded, and safe abortion and family planning included as essential health care services during emergencies.

Prevalence, Indications and Complications for Cesarean Sections at District Hospital of Eastern Nepal

Introduction: Cesarean Section (CS) is one of the most common obstetric operative procedures. The procedure of cesarean section is still challenging in hospitals, from rural areas of low-income countries like Nepal, where health resources remain scarce and limited. The aim of this study is to understand the prevalence of cesarean section, clinical indications that prompts CS and maternal complications following CS. Methods: In this descriptive cross-sectional study, all cases of delivery at Ilam District Hospital from Jul 16, 2017 to Jul 15, 2018 were included. Ethical approval was obtained from the institution. Patients attending the hospital were from hilly and remote areas of Ilam, Pachthar and Taplejung districts. The prevalence, clinical indications and outcomes of CS were recorded. Data analysis were conducted using Microsoft Excel. Results: The prevalence of cesarean section was 162(14.70%). The mean maternal age was 24.59 (range 17-39) years. Fetal distress was the leading indication and accounted for 57(35.18%) cases for CS, followed by non-progress of labour 40(24.69%), failed induction 23(14.19%), Cephalopelvic disproportion 17(10.49%) and Breech or malpresentation 11(6.79%). Most of the patients were primigravida 115(70.98%) and mean gestational weeks was 40.21(range 36-44). No major maternal complications were noted. Neonatal mean weight was 3.52(2-5.5) kg and APGAR score of more than 6 at 5th minute were recorded in 158 (97.53%) of newborns. Conclusion: The CS prevalence in our study was within the WHO recommendations of 10-15%. The leading indications for CS were fetal distress and no major complications were seen in mothers or newborns following CS