Early Estimates of the Indirect Effects of the Coronavirus Pandemic on Maternal and Child Mortality in Low- and Middle-Income Countries

Background: While the coronavirus pandemic will increase mortality due to COVID-19, the indirect effects of the pandemic will likely increase mortality from other diseases. In this study, we estimate the additional maternal and under-five child deaths resulting from weakened health systems and reduced utilization of routine services during the pandemic. Methods: We modeled three scenarios in which coverage of basic life-saving interventions is reduced to different extents (10% to 50%) and for different durations (3, 6, and 12 months), using assumptions based on emerging reports of the supply-side and demand-side effects of the pandemic. We used the Lives Saved Tool (LiST) to model maternal and under-five child mortality for each scenario in 118 low- and middleincome countries. Findings: Reductions in coverage of around 15% for 6 months would result in 253,500 additional child deaths and 12,190 additional maternal deaths, while reductions of around 45% for 6 months would result in 1,157,000 additional child deaths and 56,700 additional maternal deaths. This would represent a 9·8% to 44·7% increase in underfive child deaths per month, and an 8·3% to 38·6% increase in maternal deaths per month, across the 118 countries. Interpretation: Our estimates are based on tentative assumptions and represent a wide range of outcomes. Nonetheless, they show that if routine health care is disrupted – as a result of unavoidable shocks, health system collapse, or intentional choices made in responding to the pandemic – the increase in child and maternal deaths will be devastating. We hope these numbers add context as policy makers establish guidelines and allocate resources in the days and months to come. Funding: This study was supported by the Bill & Melinda Gates Foundation and Global Affairs Canada, who fund the Lives Saved Tool. Conflict of Interest: The authors declare no conflicts of interest.