Maternal and child health services during the COVID-19 pandemic in India: an interrupted time-series analysis.

Background: The COVID-19 pandemic posed significant challenges to healthcare systems worldwide. Maintaining essential health services, including maternal and child health (MCH), while addressing the pandemic is an enormous task. This study aimed to assess the impact of the COVID-19 pandemic on the utilization of MCH services in India's public primary care. It extends prior work by applying nationwide HMIS data within an interrupted time-series framework with seasonal and ARMA adjustments to estimate counterfactual trends, thereby providing national-level insights into both immediate and evolving disruptions. Methods: A retrospective analysis using Health Management Information System (HMIS) data examined 12 indicators of service utilization, covering maternal health, child health, deliveries, and newborn care. Interrupted time-series analysis compared pre-pandemic (April 2017-March 2020) and pandemic (March 2020-May 2021) was performed using Ordinary Least Squares (OLS) and Generalized Least Squares (GLS) regression models, adjusting for seasonality and autocorrelation with ARMA terms. Results: Antenatal care (ANC) registrations decreased by 346,420 cases (-12.8%, p = 0.026) following the onset of the pandemic, with no significant recovery in the subsequent months. Tetanus toxoid vaccinations also declined markedly, with Td1 and Td2 falling by 276,152 (-13.9%, p = 0.029) and 306,607 (-16.9%, p = 0.010) cases, respectively, and remaining consistently below expected levels. Institutional deliveries dropped by 272,441 (-13.7%, p = 0.067), while home deliveries attended by skilled birth attendants decreased by 5,054 cases (-22.8%, p = 0.014). Child health services, including referrals to Special Newborn Care Units (SNCUs) and inborn admissions, were also lower than anticipated (-20.4% and -19.2%, respectively), though these changes were not statistically significant. Among all indicators, the largest and most persistent disruptions occurred in obstetric complications (maximum decline during Winter 2020-21) and SNCU inborn admissions (also at their lowest in Winter 2020-21). These two services showed minimal signs of recovery throughout the study period, underscoring the particular vulnerability of emergency obstetric and neonatal care during public health crises. Conclusions: The COVID-19 pandemic caused declines in MCH service utilization, with varying recovery across indicators. While services like antenatal care and vaccinations showed some stabilization over time, child health admissions and obstetric complications remained below pre-pandemic trends. Strengthening healthcare systems to maintain essential services and support recovery during and after public health emergencies is critical.