Out-of-pocket Expenditure for Antenatal Care Instills amidst Free Health Care Provision: Evidence from a Large Pregnancy Cohort in Rural Sri Lanka

Gunarathne, Sajaan Praveena; Wickramasinghe, Nuwan Darshana; Agampodi, Thilini Chanchala; Prasanna, Indika Ruwan; Agampodi, Suneth Buddhika

doi:10.21203/rs.3.rs-1891492/v1

Cited by 2 publications

(4 citation statements)

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“…In this study, the pregnancy expenditure of the pregnant women delivered during the COVID-19 pandemic did not differ from the expenditure incurred for pregnant women delivered before the COVID-19 pandemic. Pregnancy expenditure is identified as an economic burden in the same study setting, since it exceeds more than 10% of household income 25 26. This is problematic for the households whose income was affected, pushed into poverty and the pregnancy and household expenditure remained unchanged during the pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…The reason was unavailability and the inability to seek work due to pandemics and curfews 35. Daily income earners must spend 70.0% of per day’s income per visit to antenatal care in rural Sri Lanka 26. As reported in Pakistan,36 this could impact pregnant women’s mental health.…”

Section: Discussionmentioning

confidence: 99%

“…35 Daily income earners must spend 70.0% of per day's income per visit to antenatal care in rural Sri Lanka. 26 As reported in Pakistan, 36 this could impact pregnant women's mental health. Household income reduction and poverty due to the pandemic were common phenomena, as documented by many researchers.…”

Section: Open Accessmentioning

confidence: 93%

“…However, the COVID-19 pandemic caused a higher prevalence of anxiety and depression among pregnant women, requiring additional support from the family and field health officers 24. This could be worse if the household economy were affected, since the income status was associated with the pregnancy expenditure25 26 and pregnancy nutritional status 27. Available evidence indicates that the COVID-19 pandemic created an economic meltdown at the household level and the Sri Lankan economy 28…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2023

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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.

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Section: Discussionmentioning

confidence: 99%