CHENNAI: Tamil Nadu’s emergency healthcare system not only withstood the unprecedented strain of the COVID-19 pandemic but emerged stronger in its aftermath, driving marked improvements in maternal and newborn health outcomes, according to a major study by researchers from the Indian Institute of Technology Madras (IIT-M).
The study, based on eight years of ambulance registry data from the State’s 108 emergency response system between 2017 and 2024, found that sustained investments in emergency medical services (EMS), maternal care infrastructure and referral systems significantly improved outcomes for pregnant women and infants during the post-pandemic recovery phase.
Published in the peer-reviewed journal BMC Pregnancy and Childbirth, the study analysed pregnancy-related emergency calls, ambulance response efficiency and maternal and neonatal indicators across Tamil Nadu’s 42 districts, covering a population of more than 84 million.
The research was led by P Kandaswamy, retired IPS officer and Professor of Practice in the Departments of Management Studies and Data Science and AI at IIT-M, along with Ashwin Prakash of Moody’s Analytics, Bengaluru.
The findings assume significance as several global studies documented severe disruptions in maternal healthcare during the pandemic, including surges in maternal deaths, home deliveries and reduced access to institutional care. However, the Tamil Nadu study presents a contrasting picture of recovery and resilience.
“During the pandemic, particularly in Wave-2, Tamil Nadu witnessed severe disruptions in maternal healthcare access. Pregnant women faced difficulties in reaching hospitals, home deliveries surged and maternal mortality rose sharply,” Kandaswamy said.
“Against this backdrop, the research sought to understand whether these disruptions had long-term adverse effects or if the system recovered. The findings present a strong and encouraging counter-narrative,” he added.
The study found that despite a steep rise in pregnancy-related emergency calls during the pandemic years, key ambulance performance indicators improved significantly after the first wave and remained efficient through 2023 and 2024.
Response time for non-inter-facility pregnancy emergencies fell by more than 46 per cent during the resilient recovery period compared to pre-pandemic levels, while transfer time and hospital handoff time also recorded sustained reductions.
Researchers attributed the improvement to rapid augmentation of ambulance fleets, expansion of healthcare manpower and strengthening of referral systems during and after the pandemic.
The study noted that Tamil Nadu’s tiered referral mechanism, linking primary health centres, district hospitals and medical college hospitals through the 108 ambulance network, played a crucial role in ensuring timely obstetric care.
More importantly, maternal and newborn health indicators recorded substantial gains during the post-pandemic resilient phase of 2023-24.
Maternal mortality declined by 19 per cent to 37 deaths per 100,000 live births, significantly lower than the national average of 97. Home deliveries fell by more than 36 per cent, miscarriages dropped by 28 per cent and complicated vaginal births declined by over 19 per cent. Neonatal mortality and infant mortality also reduced by 17 per cent and 19 per cent respectively.
Ashwin Prakash said the data suggested that sustained public investment during the pandemic years had produced long-term gains in maternal and neonatal healthcare.
“The improvements seen in the resilient phase indicate that investments in emergency response systems, healthcare personnel and maternal health programmes did not merely offset pandemic-related damage, but helped achieve outcomes better than the pre-pandemic baseline,” he said.
The researchers said the study was among the first large-scale analyses globally to examine both EMS operational efficiency and population-level maternal outcomes across multiple phases of the pandemic instead of treating COVID-19 as a single event.
The paper divided the pandemic period into eight distinct phases, including three major waves and post-wave recovery periods, allowing researchers to assess how healthcare delivery evolved over time.
The study also highlighted how Tamil Nadu’s maternal healthcare schemes, including risk-stratified antenatal care and integrated referral transport, helped sustain continuity of care even during peak pandemic disruption.
At the same time, the authors cautioned that the study established strong associations rather than definitive causation between improved EMS performance and better maternal outcomes.
They also acknowledged limitations such as reliance on aggregate data and the need for longer-term qualitative research involving healthcare workers, ambulance personnel and families to establish direct causal links.
Still, the findings offer what researchers describe as a replicable public health model for other Indian States with higher maternal mortality and weaker emergency referral systems.
“The reproductive health of women in Tamil Nadu does not appear to have been permanently undermined by the pandemic,” the study observed.