Accessing Antenatal Care (ANC) services during the COVID-19 first wave: insights into decision-making in rural India

Abstract

Plain language summary This article highlights the status of ANC services during the nationwide lockdown imposed in the first wave of the COVID-19 pandemic in the Indian states of Jharkhand, Madhya Pradesh and Uttar Pradesh. Data was collected through 12 in-depth interviews with pregnant women and 17 in-depth interviews with frontline health workers. Findings suggest that pregnant women were aware of the unprecedented threat of COVID-19 and recommended protective measures through trusted sources of information, including their local Accredited Social Health Activist (ASHA). However, both pregnant women and FLHWs believed that the information they received on the health risks of the pandemic and strategies to address these was inadequate. Temporary suspension of health services in the rural countryside meant that pregnant women could not track the foetus's health status, resulting in confusion and distress. Limited or no interaction with FLHWs, coupled with a reported lack of attention to conditions unrelated to COVID-19 and discrimination at healthcare institutions increased the uncertainty around institutional deliveries. This was further heightened by the loss of livelihoods due to the shutdown of businesses during the lockdown, as the respondents could not turn to private hospitals for childbirth. This resulted in the collapse of the trust of pregnant women and their families in the public healthcare system. To bridge this gap and alleviate the sense of mistrust the pandemic has created in its end-users, strategies to improve the utilisation of health services should respond to the barriers identified in this study.

Keywords

• Antenatal care services
• Behavioral principles
• Childbirth
• COVID-19
• India
• Pregnant women