A double-edged sword - Telemedicine for maternal care during COVID-19: Findings from a global mixed methods study of healthcare providers

Galle, A.; Semaan, A.; Huysmans, E.; Audet, C.; Asefa, A.; Delvaux, T.; Afolabi, B. B.; El Ayadi, A.; Benova, L.

Introduction The COVID-19 pandemic has led to a rapid and wide implementation of telemedicine for provision of maternal and newborn health care worldwide. Studies conducted before the pandemic, mainly deriving from high-income countries, showed telemedicine was a safe and cost-effective tool for delivering healthcare under certain conditions. The objective of this study was to document the experiences of healthcare professionals globally with the provision of telemedicine for maternal and newborn healthcare during the COVID-19 pandemic. Methods We analysed responses received to the second round of a global, online survey of maternal and newborn health professionals, disseminated through professional networks and social media in 11 languages. Data were collected between July 5, 2020 and September 10, 2020. The questionnaire included questions regarding background, preparedness for and response to COVID-19 and experiences with providing telemedicine during the pandemic. Descriptive statistics and qualitative thematic analysis were used concurrently to analyse responses, disaggregated by country income level. Results Responses from 1,060 maternal and newborn health professional were analysed. Among the sample, 58% reported using telemedicine, with the lowest proportion reported by professionals working in low-income countries (24%). Two fifths of telemedicine users reported not receiving guidelines on the provision of care through technology. Key practices along the continuum of maternal and newborn healthcare provided through telemedicine included online group birth preparedness classes, antenatal and postnatal care by video/phone, setting up a COVID-19 helpline at maternity wards, and online psychosocial counselling. Challenges reported technological barriers, lack of technological literacy, financial and language barriers, lack of nonverbal feedback, and distrust from patients. Maternal and newborn health providers considered telemedicine to be an important alternative to in-person consultations to maintain care provision during the COVID-19 pandemic. However, they also emphasized the lower quality of care and risk of increasing the already existing inequalities in access to healthcare. Conclusions Telemedicine has been applied globally to address the disruptions of care provision during the COVID-19 pandemic. However, some crucial aspects of maternal and newborn healthcare seem difficult to deliver by telemedicine. Pitfalls of health care provision by telemedicine include exacerbated inequalities in access to care, patient-provider communication problems, and a financial burden for certain healthcare workers and women. More research regarding the effectiveness, efficacy, and quality of telemedicine for maternal health care in different contexts is highly needed before considering long-term adaptations in provision of care away from face to face interactions. Clear guidelines for care provision and approaches to minimising socio-economic and technological inequalities in access to care are urgently needed.