Indirect effects of the early phase of the COVID-19 pandemic on the coverage of essential maternal and newborn health services in a rural subdistrict in Bangladesh: results from a cross-sectional household survey

Abstract

ObjectiveThis paper presents the effect of the early phase of COVID-19 on the coverage of essential maternal and newborn health (MNH) services in a rural subdistrict of Bangladesh.DesignCross-sectional household survey with random sampling.SettingBaliakandi subdistrict, Rajbari district, Bangladesh.ParticipantsData were collected from women who were on the third trimester of pregnancy during the early phase of the pandemic (111) and pre-pandemic periods (115) to measure antenatal care (ANC) service coverage. To measure birth, postnatal care (PNC) and essential newborn care (ENC), data were collected from women who had a history of delivery during the early phase of the pandemic (163) and pre-pandemic periods (166).ExposureEarly phase of the pandemic included a strict national lockdown between April and June 2020, and pre-pandemic was defined as August–October 2019.Outcome of interestChanges in the coverage of selected MNH services (ANC, birth, PNC, ENC) during the early phase of COVID-19 pandemic compared with the pre-pandemic period, estimated by two-sample proportion tests.FindingsAmong women who were on the third trimester of pregnancy during the early phase of the pandemic period, 77% (95% CI: 70% to 85%) received at least one ANC from a medically trained provider (MTP) during the third trimester, compared with 83% (95% CI: 76% to 90%) during the pre-pandemic period (p=0.33). Among women who gave birth during the early phase of the pandemic period, 72% (95% CI: 66% to 79%) were attended by an MTP, compared with 63% (95% CI: 56% to 71%) during the pre-pandemic period (p=0.08). Early initiation of breast feeding was practised among 38% (95% CI: 31% to 46%) of the babies born during the early phase of the pandemic period. It was 37% (95% CI: 29% to 44%) during the pre-pandemic period (p=0.81). The coverage of ANC, birth, PNC and ENC did not differ by months of pandemic and pre-pandemic periods; only the coverage of at least one ANC from an MTP significantly differed among the women who were 7 months pregnant during the early phase of the pandemic (35%, 95% CI: 26% to 44%) and pre-pandemic (49%, 95% CI: 39% to 58%) (p=0.04).ConclusionThe effect of the early phase of the pandemic including lockdown on the selected MNH service coverage was null in the study area. The nature of the lockdown, the availability and accessibility of private sector health services in that area, and the combating strategies at the rural level made it possible for the women to avail the required MNH services.

A Qualitative Assessment of the Essential Health and Nutrition Service Delivery in the Context of COVID-19 in Bangladesh: The Perspective of Divisional Directors

“…These disruptions have led to worrisome impacts, including a decrease in vaccination (i.e., one-fourth of newborn babies were not vaccinated during the pandemic [ 12 ]) and increased child deaths (12.8%) and maternal deaths (7.6%) [ 9 ]. Similar disruptions have been reported in other studies focusing specifically on rural sub-districts or urban areas [ 14 ]. In addition, a qualitative study of 15 pregnant women in Khulna revealed how they experienced socioeconomic hardships (loss of income, difficulty in receiving loans, and a lack of transportation) and emotional distress (fear, worry, and sadness [ 10 ]).…”

“…The triangulation of the survey data and interviews with pregnant women confirmed these fears. On the one hand, two in five households restrained from seeking healthcare due to fears of infection [ 12 ], and pregnant women avoided ANC visits, especially in the third trimester [ 14 ]. On the other, pregnant women expressed that their risk assessments involved emotional distress but also socioeconomic hardships, such as a loss of income [ 10 ].…”

Delivering quality care to all mothers and newborns requires governments to engage the private sector

“…In Mexico, for example, the Mexican Institute of Social Security contracted out private hospitals to provide childbirth services so that public hospital beds could be used for covid-19 patients 15. Service delivery data from Bangladesh documented that the private sector was able to maintain pre-pandemic population level service coverage of facility based delivery, antenatal care, and postnatal care services at the beginning of the pandemic 16…”

Utilization of Postnatal Care Services among Thai Women during the COVID-19 Pandemic: Results of a Web-Based Survey

“…Moreover, the coronavirus disease (COVID-19), emerging from the Hubei Province in the People’s Republic of China in December 2019 and subsequently spreading throughout the world, has resulted in alterations to healthcare structures and processes, such as reduced maternity service provision, including PNC [ 7 , 8 , 9 , 10 , 11 , 12 ]. However, to our knowledge, only a few studies have examined the PNC uptake using a quantitative approach during the pandemic in Ethiopia [ 13 ], Bangladesh [ 14 ], and the UK [ 15 ].…”