Accessing Antenatal Care (ANC) services during the COVID-19 First Wave - Insights into decision-making process from rural India

Abstract

Background Antenatal Care (ANC) services are a prime focus of the National Health Mission (NHM) of the Government of India, with emphasis on promoting maternal and child health. The services are designed to reach villages with the appointment of Frontline Health Workers (FLHWs) and the establishment of a network of health centres at the primary level for uninterrupted service delivery. However, with the onset of the COVID-19 pandemic and the outcomes of the national lockdown from late March to June 2020 the decisions to access these services were impacted. Methods Using a qualitative design, data were collected through 12 in-depth interviews (IDIs) with pregnant women and 17 IDIs with frontline health workers in the selected six districts under study. The narratives were analysed using inductive coding in Atlas.ti. Results Pregnant women, most of whom belonged to poor and marginalised groups, were left with limited access to health centres and FLHWs. Respondents from the study areas of rural Jharkhand, Madhya Pradesh and Uttar Pradesh extensively reported concerns stemming from the lockdown that influenced their decision around accessing ANC services . These included anxieties around meeting their families’ daily needs due to a loss of livelihood (in particular, abject food insecurity), inability to access healthcare, and a sense of mistrust in public health systems and functionaries. All of these, coupled with the real threat to health posed by COVID-19, threw their plans for pregnancy and delivery into jeopardy. Conclusion This study identified a number of behavioural, social and structural factors deeply entrenched in the communities, which resulted in confusion and anxiety, leaving pregnant women and FLHWs feeling hapless and helpless. To ensure ANC services in times of crisis, strategies to address the behavioural, social and structural concerns and place ANC services as essential services in the study area and in similar contexts need to take into account the factors identified by this study.