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Protecting hard-won gains for mothers and newborns in low-income and middle-income countries in the face of COVID-19: call for a service safety net
  1. Wendy Jane Graham1,
  2. Bosede Afolabi2,
  3. Lenka Benova3,
  4. Oona Maeve Renee Campbell1,
  5. Veronique Filippi4,
  6. Annettee Nakimuli5,
  7. Loveday Penn-Kekana1,
  8. Gaurav Sharma6,
  9. Uduak Okomo7,
  10. Sandra Valongueiro8,
  11. Peter Waiswa9,
  12. Carine Ronsmans4
  1. 1Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  2. 2Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Akoka, Lagos, Nigeria
  3. 3Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
  4. 4Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
  5. 5Obstetrics and Gynecology, Makerere University and Mulago National Referral Hospital, Kampala, Uganda
  6. 6Independent Consultant, Kathmandu, Nepal
  7. 7Vaccines and Immunity Theme, MRC Unit-Gambia, Banjul, Gambia
  8. 8Postgraduate Program of Public Health, Universidade Federal de Pernambuco, Recife, Brazil
  9. 9School of Public Health, Makerere University, Kampala, Uganda
  1. Correspondence to Professor Wendy Jane Graham; Wendy.Graham{at}

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  • The adverse impact of COVID-19 on maternal and newborn services in low-income and middle-income countries risks undermining improvements in health outcomes and care achieved over the last three decades.

  • Alarming declines in the use of services and in the quality of care in health facilities are being reported from sources on the ground, captured rapidly and in real time using e-communication tools.

  • Local solutions to the direct and indirect challenges brought to maternal and newborn health services by COVID-19 must be captured effectively and shared efficiently to support health workers and managers.

  • Providing adequate funding to maintain essential services alongside urgent action plans for COVID-19 is essential to enable rapid adaptation and modifications to service delivery in response to different transmission scenarios and stages of the pandemic.

There are an estimated 5. 4 million largely preventable maternal and perinatal deaths each year.1–3 Improving the survival and well-being of mothers and newborns is indisputably a global priority. This is as true today as ever and as the world grapples with the COVID-19 pandemic. For maternal and newborn health (MNH), a critical question today is not only the extent to which pregnant or postpartum women and newborns are vulnerable to COVID-19-infection4 but also the degree to which the safety of giving birth and accessing treatment for complications in health facilities is being compromised by the direct and indirect effects of the virus, thereby reversing hard progress in MNH over the last 30 years. We know that infectious disease outbreaks can devastate provision of such care, for example, during the Ebola outbreak in West Africa.5 In this commentary, we use insights from those on the ground in low-income and middle-income countries (LMICs) to highlight both the impact of COVID-19 on facility births and the innovative local solutions being …

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