Chennai, May 21: Indian Institute of Technology Madras (IIT Madras) researchers have found that sustained investments in emergency medical services (EMS) and maternal healthcare not only offset the severe disruptions caused by the COVID-19 pandemic but also led to significantly improved maternal and newborn health outcomes in Tamil Nadu during the post-pandemic period.
The study analysed eight years of real-world ambulance registry data (2017–2024) from Tamil Nadu’s 108 emergency response system. The research examined how the state’s healthcare system performed across multiple pandemic phases and into the resilient recovery period of 2023–2024.
With data spanning 42 districts and a population of over 84 million, the study provides an unprecedented scale of analysis compared to earlier research, which has largely been limited to individual hospitals or smaller regions.
The implications extend far beyond Tamil Nadu. The findings reinforce that strategic public investment including expansion of ambulance fleets, strengthening of referral systems, and targeted maternal health schemes can significantly improve health outcomes, even during large-scale crises.
The Research was led by Prof. P Kandaswamy, a Retired IPS Officer, who is currently a Professor of Practice in the Departments of Management Studies and Data Science and AI, IIT Madras, along with Mr. Ashwin Prakash, Moody’s Analytics Pvt Ltd, Bengaluru
The findings were published in BMC Pregnancy and Childbirth (https://doi.org/
Speaking about this Research, Prof. P Kandaswamy IPS (Retd), Professor of Practice, Departments of Management Studies (DoMS) & Data Science and AI, IIT Madras, said, “During the pandemic, particularly in Wave-2, Tamil Nadu witnessed severe disruptions in maternal healthcare access. Pregnant women faced challenges in reaching hospitals, home deliveries surged, and maternal mortality rose sharply by 98.5 per cent compared to pre-pandemic levels. 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.”
Despite a sharp rise in pregnancy-related emergency calls during the pandemic, key EMS performance indicators — including response time, patient transfer time, and hospital handoff time — improved significantly after the first wave and continued to remain efficient through 2023–2024.
Elaborating on the findings, Co-Author Mr. Ashwin Prakash, Moody’s Analytics Pvt Ltd, said, “More importantly, maternal and newborn health indicators showed substantial improvement in the post-pandemic resilient phase compared to pre-pandemic baselines. Maternal mortality declined by 19 per cent to 37 deaths per 100,000 live births, which is far below India’s national average. Home deliveries reduced by over 36 per cent, miscarriages dropped by 28 per cent and complicated vaginal births declined by over 19 per cent. Neonatal and infant mortality also saw reductions of 17 per cent and 19 per cent, respectively.”
The researchers concluded that sustained government investments in EMS infrastructure, healthcare workforce expansion and maternal health programmes not only neutralised the pandemic’s adverse effects but resulted in outcomes that surpassed pre-pandemic levels.
This study stands out globally for offering an evidence-based counterpoint to widely reported healthcare system failures during COVID-19. Instead of treating the pandemic as a single event, the research breaks it into eight distinct phases, enabling a granular analysis of how healthcare delivery evolved over time.
Another unique aspect is its dual-track approach of simultaneously evaluating EMS operational efficiency and population-level maternal and neonatal outcomes. The study also employed robust statistical techniques suited to real-world, non-ideal datasets, ensuring reliability despite the absence of controlled experimental conditions.
For India, the Tamil Nadu model offers a blueprint for states with higher maternal mortality and weaker emergency systems. Programmes such as risk-stratified antenatal care and the 108 ambulance network demonstrate how integrated, tiered healthcare delivery can enhance resilience.
The researchers, however, caution that the study establishes strong associations but not direct causation between EMS improvements and health outcomes. They also note limitations such as reliance on aggregate data and the need for longer-term analysis.