Impact of COVID-19 pandemic on health service utilisation and household economy of pregnant and postpartum women: a cross-sectional study from rural Sri Lanka

Abstract

ObjectivesThis study aims to describe how household economies and health service utilisation of pregnant and postpartum women were affected during the pandemic.DesignA cross-sectional study.SettingThis study was conducted in the Anuradhapura district, Sri Lanka.ParticipantsThe study participants were 1460 pregnant and postpartum women recruited for the Rajarata Pregnancy Cohort during the initial stage of the COVID-19 pandemic.Primary and secondary outcome measuresHousehold economic (income, poverty, nutritional and health expenditures) and health service utilisation details during the COVID-19 pandemic were gathered through telephone interviews. Sociodemographic and economic data were obtained from the cohort baseline and analysed with descriptive and non-parametric analysis.ResultsOut of the 1460 women in the sample, 55.3% (n=807) were pregnant and 44.7% (n=653) were postpartum women. Of the total sample, 1172 (80.3%) women participated in the economic component. The monthly household income (median (IQR)=212.39 (159.29–265.49)) reduced (median (IQR)=159.29 (106.20–212.39)) in 50.5% (n=592) families during the pandemic (Z=−8.555, p<0.001). Only 10.3% (n=61) of affected families had received financial assistance from the government, which was only 46.4% of the affected income. The nutritional expenditure of pregnant women was reduced (Z=−2.023, p=0.043) by 6.7%. During the pandemic, 103 (8.8%) families with pregnant or postpartum women were pushed into poverty, and families who were pushed into poverty did not receive any financial assistance. The majority of women (n=1096, 83.3%) were satisfied with the free public health services provided by the public health midwife during the pandemic.ConclusionDuring the early stages of the pandemic, healthcare utilisation of pregnant women was minimally affected. Even before the country’s current economic crisis, the household economies of pregnant women in rural Sri Lanka were severely affected, pushing families into poverty due to the pandemic. The impact of COVID-19 and the aftermath on pregnant women will have many consequences if the policies and strategies are not revised to address this issue.

Lesson Learned During a Pandemic: A Phenomenological Study of Pregnant Women’s Experience in Resource-Limited Setting

“…36 Various studies have reported unequal socioeconomic impacts of the COVID-19 pandemic. 33,37,38 Our research also revealed that social engagement is beneficial during pregnancy. Being in the company of loved ones and receiving visits and support from family members, close relatives, and friends can help alleviate emotional and psychological burdens throughout the pregnancy journey.…”

“…Conversely, another study found that despite the aforementioned fears, pregnant women's utilization of healthcare services experienced only minimal disruption during the initial phases of the pandemic. 33 The findings of our study revealed that during the interviews, pregnant women emphasized their own experiences regarding the measures taken to prevent the spread of COVID-19. They expressed a mixed level of trust in these preventive tactics.…”

Out-of-Pocket Expenditure for Antenatal Care Amid Free Health Care Provision: Evidence From a Large Pregnancy Cohort in Rural Sri Lanka

“…38,39 Pregnant women in Sri Lanka use the government health system more often than the private health system during pregnancy. 39 A few studies have assessed the economic burden of ANC 40,41 and postnatal morbidities, 42 economic impact on pregnant women during COVID-19, 43 and the impact of social determinants and economic factors on maternal deaths 44 and maternal nutrition cost [45][46][47][48] in rural Sri Lanka. Recent evidence suggests that, despite having access to free maternal health services, pregnant women have substantial OOP expenditure, even while using government health facilities in Sri Lanka.…”