Centre for Social and Behaviour Change, Ashoka University, Haryana, India.
Reprod Health. 2022 Jul 8;19(1):158. doi: 10.1186/s12978-022-01446-2.
Antenatal care (ANC) services are a prime focus of the Government of India's National Health Mission (NHM), of which a key pillar is the promotion of maternal and child health. To ensure uninterrupted service delivery at the last mile, a cadre of Frontline Health Workers (FLHWs) has been appointed and health centres established at the village level. However, the onset of the COVID-19 pandemic and the nationwide lockdown from late March to June 2020 impacted pregnant women's access to institutional antenatal care services.
Using a qualitative research design, data was collected through 12 in-depth interviews (IDIs) with pregnant women and 17 IDIs with frontline health workers in the selected six districts under study. The narratives were analysed using inductive coding in Atlas.ti.
During the first wave of the COVID-19 pandemic, pregnant women, most of whom belonged to poor and marginalised groups, were left with limited access to health centres and FLHWs. Respondents from the study areas of rural Jharkhand, Madhya Pradesh and Uttar Pradesh extensively reported concerns stemming from the lockdown that influenced their decision to access ANC services. These included anxieties around meeting their families' daily needs due to a loss of livelihood (in particular, abject food insecurity), inability to access healthcare, and a sense of mistrust in public health systems and functionaries. All of these, coupled with the real threat to health posed by COVID-19, disrupted their plans for pregnancy and delivery, further compunding the risk to their health and wellbeing.
This study identified several social, behavioural and structural facets of the communities that contributed to the confusion, anxiety and helplessness experienced during the COVID-19 first wave by both groups, viz. pregnant women and FLHWs. In planning and implementing initiaves to ensure the delivery and uptake of ANC services in this and similar contexts during times of crisis, these facets must be considered.
产前护理 (ANC) 服务是印度政府国家健康使命 (NHM) 的主要重点，其中一个关键支柱是促进母婴健康。为了确保最后一英里的服务不间断，已经任命了一线卫生工作者 (FLHW) 人员，并在村级设立了保健中心。然而，2020 年 3 月下旬至 6 月全国封锁期间，新冠疫情的爆发和全国封锁影响了孕妇获得机构产前护理服务的机会。
使用定性研究设计，通过在研究的六个选定地区的 12 名孕妇和 17 名一线卫生工作者进行深入访谈 (IDIs) 收集数据。使用 Atlas.ti 中的归纳编码对叙述进行分析。
在第一波新冠疫情期间，大多数属于贫困和边缘群体的孕妇获得卫生中心和 FLHW 的机会有限。来自印度恰尔肯德邦、中央邦和北方邦农村地区研究领域的受访者广泛报告了由于封锁而产生的对影响他们接受 ANC 服务的决定的担忧。这些担忧包括由于丧失生计（特别是严重的粮食不安全）而无法满足家庭日常需求、无法获得医疗保健以及对公共卫生系统和工作人员的不信任感。所有这些，加上新冠疫情对健康构成的实际威胁，打乱了她们的怀孕和分娩计划，进一步增加了她们的健康和福祉风险。
本研究确定了社区的几个社会、行为和结构方面，这些方面导致了两组人员，即孕妇和 FLHW，在第一波新冠疫情期间感到困惑、焦虑和无助。在规划和实施计划以确保在危机期间在这种情况下和类似情况下提供和接受 ANC 服务时，必须考虑到这些方面。
