‘I was scared I will end up in another abortion’: a mixed-methods study assessing the impact of COVID-19 pandemic and lockdown on the antenatal care of pregnant women in Puducherry, South India

Abstract

Background As a mitigation measure for COVID-19 pandemic, lockdown was implemented in India for a period of 2 months (24 March–31 May 2020). Disruption in antenatal care (ANC) provisions during lockdown is expected due to diversion of public health facilities on pandemic. Objective To assess the proportion of pregnant women who had not completed the ideal number of antenatal visits, availability of iron–folic acid (IFA) supplements and challenges in availing health services during the period of lockdown. Methods A concurrent mixed-methods study was conducted among pregnant women in Puducherry, India. Information on obstetric characteristics and details regarding antenatal visits were collected through telephonic interviews. In-depth interviews were conducted to understand the perceived challenges in availing health services during the lockdown period. Results Out of 150 pregnant women, 62 [41.3%; 95% confidence interval (CI) 33.6–49.3] did not complete the ideal number of visits and 61 (40.7%, 95% CI 32.7–49.0) developed health problems. Out of 44 women who received medical care for health problems, 11 (25%) used teleconsultation. Of all the women, 13 (8.7%, 95% CI 4.9–14.0) had not taken the IFA supplements as prescribed by the health provider. Economic hardship, restricted mobility, lack of information about the health system changes and psychological stress due to the fear of COVID were the challenges in accessing care. Conclusions Two out of five pregnant women did not complete the ideal number of visits and developed health problems during the lockdown period.

Impact on Public Health Nutrition Services Due to COVID-19 Pandemic in India: A Scoping Review of Primary Studies on Health and Social Security Determinants Affecting the First 1000 Days of Life

“…Out of 150 pregnant women, 41% of women did not complete the ideal number of visits and 40% developed health problems. Major challenges to health service access included economic hardships, restricted mobility, lack of information about health system changes, and psychological stress [ 23 ].…”

A Systematic review of factors affecting compliance toward oral iron-folic acid supplementation among pregnant women in India.

“…Information on obstetric characteristics and details regarding antenatal and to understand the perceived challenges in availing of health services were collected through telephonic interviews during the lockdown period. (14) In 2018, Ahamad F et al conducted a community-based open-labeled parallel block randomized controlled trial among 400 pregnant women in a rural area of Haryana north India. In the intervention group, the first time IFA supplementation was given by ASHA workers every week and after being given the first dose pregnant women were counseled to take the remaining tablets during the week as per the advice by a health professional.…”

“…Women who were counseled by health care professionals about IFA supplementation, its correct dosage, time of administration, benefits, and its importance were more likely to be associated with good compliance. (18,14,(19)(20)(21) Six studies also showed the association of history of anemia and knowledge about anemia with the compliance of IFA supplementation. Most of the studies showed that pregnant women who knew about anemia were significantly associated with good compliance.…”

“…Nonanemic pregnant women showed better compliance compared to anemic pregnant women beside an improvement in Hb levels showed increased compliance to IFA supplementation. (18,14,(22)(23)(24)(25) Timing of registration and number of Antenatal Care (ANC) visits: Based on a systematic review nine studies reported the timing of ANC registration and the number of ANC visits was significantly associated with compliance with IFA supplementations. Women who had started their ANC visit in the initial period of pregnancy were more likely to show good compliance in comparison to those who started their visit in the last period of pregnancy.…”

Resolution of Resilience: Empirical Findings on the Challenges Faced and the Mitigation Strategies Adopted by Community Health Workers (CHWs) to Provide Maternal and Child Health (MCH) Services during the COVID-19 Pandemic in the Context of Odisha, India

“…Researchers have identified the shortfalls in the provision and utilization of routine MCH services during the current pandemic. A drop in utilization of antenatal care (ANC) and post-natal care (PNC) [ 5 , 6 ], institutional delivery [ 7 ], routine immunization services [ 8 , 9 ], and family planning services [ 10 ] signifies the lapses in MCH care due to the COVID-19 pandemic. Prior to the onset of the pandemic, the state of Odisha was making great efforts to improve its maternal and child health indicators [ 11 ] to achieve the figures targeted under sustainable development goals (SDG).…”