Accessing Maternal Health Care in the Midst of the COVID-19 Pandemic: A Study in Two Districts of Assam, India

Abstract

BackgroundCOVID-19 pandemic and the subsequent national lockdown in India compelled the health system to focus on COVID-19 management. Information from the field indicated the impact of COVID- 19 on the provision of maternal health services. This research presents users' and providers' perspectives about the effect of the pandemic on maternal health services in select districts of Assam.MethodsThe study was undertaken to understand the status of maternal health service provision and challenges faced by 110 pregnant and recently delivered women, 38 health care providers and 18 Village Health Sanitation and Nutrition Committee members during COVID-19 pandemic. Telephonic interviews were conducted with the users identified through simple random sampling. Healthcare providers and the community members were identified purposively.ResultsMost of the interviewed women reported that they could access the health services, but had to spend out-of-pocket (for certain services) despite accessing the services from government health facilities. Healthcare providers highlighted the lack of transportation facilities and medicine unavailability as challenges in providing routine services. The study revealed high proportion of Caesarian section deliveries (42.6%, n = 32) and stillbirths (10.6%, n = 8).DiscussionThis research hypothesizes the supply-side (health system) factors and demand-side (community-level) factors converged to affect the access to maternal health services. Health system preparedness by ensuring availability of all services at the last mile and strengthening existing community-reliant health services is recommended for uninterrupted good quality and affordable maternal health service provision.

Measuring supply-side service disruption: a systematic review of the methods for measuring disruption in the context of maternal and newborn health services in low and middle-income settings

“…The characteristics of the 28 included studies are listed in online supplemental appendix 2. Studies were carried out in: Bangladesh,26 Ethiopia,27 28 India,29–34 Indonesia,35 36 Iran,37 38 Nepal,39 40 Nigeria41–44, and Uganda 45 46. Three studies included multiple LMIC countries,14 47 48 and four included both HICs and LMICs 49–52.…”

“…Three studies included multiple LMIC countries,14 47 48 and four included both HICs and LMICs 49–52. Most studies (n=18) used qualitative methods to collect data about supply-side disruption28 30 31 33–37 40–47 49 50; one study involved a qualitative media analysis 32. Seven studies were based on quantitative methods,14 26 27 29 38 48 52 and two used both qualitative and quantitative methods 39 51.…”

“…Seven studies were based on quantitative methods,14 26 27 29 38 48 52 and two used both qualitative and quantitative methods 39 51. Most studies (n=14) involved participation from service-providers (eg, nurses, midwives, obstetricians, community health workers, policy-makers),14 29 30 35 40 42–44 47–52 while 11 involved service users,27 31–34 36–39 45 46 and 3 included both groups 26 28 41…”

“…Semistructured interviews with healthcare workers and/or service users asking about difficulties providing care 28 30 31 33 34 36 37 39 40 42–46…”

“…Various qualitative approaches were used to generate accounts of disruptions to the provision or quality of services including: (1) semistructured interviews with service providers and/or service users to elicit descriptions of experiences of disruption,28 30 31 33 34 36 37 39–46 (2) semistructured interviews with service providers eliciting comparisons of the provision of care at different times,35 49 (3) semistructured interviews among service users asking about management, barriers, and facilitators influencing service delivery (stratified by levels of health system),47 (4) free-text field in a survey of service providers,50 51 and (5) media analysis of news reports 32. Some of these sources focused on the experiences of respondents during a lockdown period,34 or during a lockdown period compared with the period preceding or following lockdown 33 42.…”