The impact of the COVID-19 pandemic on the rate of maternal postnatal healthcare examinations in England: an OpenSAFELY interrupted time series analysis providing evidence of disparity in care access

Lay summary

We found for ~600,000 women with births events, the rate of postnatal examinations increased with length of time after birth - however, rates within the recommended six- to eight- weeks after birth reduced (↓24.1%) between January and March 2020, recovering to pre-pandemic rates by January 2023. The odds of no postnatal examination were greater for ethnic minorities (Asian or Asian British (OR 1.11, 1.09-1.14), varied by region (North East (1.39, 1.28-1.37) and West Midlands (1.33, 1.27-1.39), and greater for more deprivation populations (most deprived (1.43, 1.31-1.37)). These persisted in the post pandemic period. Addressing these disparities will require a combination of policy changes, financial incentives, and targeted, culturally appropriate interventions to ensure equitable access to care for all mothers and infants.

Abstract

Background: Clinical guidance in England currently recommends that women undergo a postnatal health and wellbeing examination with a general practitioner 6-8 weeks after giving birth. The current study aimed to describe the impact of the COVID-19 pandemic on the rate of maternal postnatal examinations in England over time and its predictors, including socioeconomic deprivation and ethnicity.

Methods: With the approval of NHS England, the OpenSAFELY platform was used to access the TPP SystmOne electronic health record (EHR) system for primary care. All records for registered female patients aged 14 to 49 years with a recorded birth coded between January 2019 and August 2023. Monthly rates of postnatal examinations were estimated based on the number of patients with a postnatal-related code within 6, 8 or 12 weeks of birth. Interrupted time-series analysis modelled the impact of the COVID-19 pandemic on the rate of examinations. Characteristics that may influence the likelihood of not having a postnatal examination were estimated using logistic regression.

Results: For 626,180 patients with births coded, the rate of postnatal examinations increased with length of time after birth. Rates within 8 weeks fell from 368 to 279 per 1000 (↓24.1%) between January and March 2020, recovering to 402 per 1000 by January 2023. The incident rate ratio for the first national lockdown was 0.87 (95%CI 0.81–0.91) for 6 weeks, 0.84 (0.81–0.87) for 8 and 1.06 (1.04–1.08) for 12 weeks. The odds of no examination were affected by ethnicity (Asian or Asian British (OR 1.11, 1.09–1.14)), region (North East (1.39, 1.28–1.37) and West Midlands (1.33, 1.27–1.39)) and deprivation (most deprived (1.43, 1.31–1.37)).

Conclusions: Maternal postnatal examinations within the recommended time were negatively affected by the onset of the pandemic. Despite rates improving over time, most failed to occur within the recommended 6–8 weeks. Significant variation in rates exists across NHS regions: rates were lower in ethnic minority groups and in more deprived populations. Addressing these disparities will require a combination of policy changes, financial incentives and targeted, culturally appropriate interventions to ensure equitable access to care for all mothers and infants.