COVID-19 Contribution to the “Three Delays” in Maternal Health Care Delivery: A Qualitative Case Study in Nigeria

Context: The COVID-19 pandemic affected all countries including low-and middle-income countries (LMICs) like Nigeria. During the crisis, health policies focused more on COVID neglecting other essential services like perinatal care. This resulted in delays and adverse perinatal outcomes. We employ the concept of the “Three delays” model to describe this further.

The Three Delays model proposes that perinatal adverse outcomes are due to delays in (1) deciding to seek appropriate medical help (2) reaching an appropriate obstetric facility, and (3) receiving adequate care having reached a health facility.

Aim: To describe pregnant women and their healthcare providers’ views about the effect of the COVID- 19 pandemic on perinatal care.

Methodology: A qualitative descriptive single-case hospital-based study using semi-structured in-depth interviews of twenty participants (pregnant women, clinicians, managers), in a tertiary hospital in North-Central Nigeria from May-Aug 2021. Data also included pictures, a review of hospital records, participant observation, and field notes. Participant selection was purposive. We analyzed data from interviews by adopting an inductive thematic analysis approach.

Results: The study showed how the pandemic affected perinatal healthcare delivery and resulted in delays. It caused avoidance of services (delay in seeking), affected access to services (delay in reaching), and affected availability and delivery of some services (delay in receiving).

Fear of going to the hospital by pregnant women led to the avoidance and underutilization of available services causing delays in seeking care. Fear by health providers and staff shortages due to the isolation of infected staff caused delays in receiving care. Transportation problems due to movement restrictions during the lockdown caused delays in reaching care while financial constraints due to the lockdown caused delays in seeking, reaching, and receiving care. In the hospital, measures like the stoppage or restriction of some perinatal services to ensure distancing caused delays in receiving care as there were no alternatives for virtual care or telemedicine.

Conclusion: The COVID-19 pandemic caused challenges that contribute to the three delays which increase the risk for adverse maternal outcomes in LMICs. These findings can be used to inform policies and develop perinatal care interventions during the COVID-19 pandemic and similar health crises in the future.