The COVID-19 pandemic significantly disrupted healthcare services globally, particularly affecting Maternal and Child Health (MCH) care in Low- and Middle-Income Countries (LMICs). Studies have documented declines in antenatal care, institutional deliveries, postnatal visits, and immunization coverage. These disruptions not only impacted the physical health of pregnant women and postnatal mothers but also negatively affected their mental well-being, increasing anxiety and stress. While existing research primarily focused on the clinical dimensions of COVID-19's impact on obstetrics, there was a scarcity of information on the challenges faced by women in accessing MCH care. This study aimed to address this gap by exploring the experiences of pregnant women and postnatal mothers in Odisha, India, during the pandemic. Understanding these challenges is crucial for developing effective strategies to ensure the continuity of essential MCH services during future health crises. The research question guiding this study is: What challenges did pregnant women and postnatal mothers in Odisha, India face in accessing MCH services during the COVID-19 pandemic?

Several studies have highlighted the detrimental effects of the COVID-19 pandemic on reproductive, maternal, newborn, child, and adolescent health (RMNCH) services. Studies from India and other LMICs reported significant reductions in antenatal care utilization, institutional deliveries, and postnatal visits. Research has also demonstrated an increase in anxiety and obsessive-compulsive symptoms among pregnant women during the pandemic. Existing literature has primarily focused on the quantitative impact, such as percentage drops in service utilization. This study contributes by providing qualitative insights into the lived experiences of pregnant women and mothers navigating MCH care during the pandemic.

This study employed an explorative qualitative design. Data were collected from February to April 2021 in Odisha, India. To maximize sampling variance, the researchers selected two districts from each of Odisha's three revenue divisions (northern, central, and southern), followed by random selection of two blocks per district. One community health center (CHC), one primary health center (PHC), and one subcenter (SC) were selected from each block. Antenatal and postnatal mothers were purposively selected as participants. Data collection involved 36 in-depth interviews (IDIs) conducted in Odia, the local language. Interviews were audio-recorded, transcribed, translated into English, and analyzed using MAXQDA software. Thematic analysis was performed by three researchers to ensure consensus on themes and categories. Ethical approval was obtained from the Institutional Ethics Committee of ICMR-RMRCB and the State Research and Ethics Committee, Odisha. Informed consent was obtained from all participants before the interviews.

The study revealed two main themes: (1) Access to MCH care services during the pandemic and (2) Impact of the pandemic on the lives of MCH care recipients. Regarding access to care, participants reported receiving substantial support from community health workers (CHWs), who provided home-based services such as health assessments, medications, and nutritional supplements. However, challenges included lack of awareness regarding community-based services, restricted mobility due to lockdowns and transportation limitations, long wait times at health facilities, and fear of COVID-19 infection leading some women to opt for home deliveries. Financially, the pandemic added a burden due to unemployment and increased healthcare expenses. The second theme highlighted the increased physical strain due to increased household workload and fear of infection, impacting the mental well-being of participants. Specific findings included: a significant number of women reporting difficulties accessing routine antenatal checkups and nutritional supplements; challenges faced in utilizing public transportation, leading to additional costs and missed appointments; and the prevalence of anxiety, fear, and stress related to pregnancy and childbirth during the pandemic.

The findings highlight the complex interplay of factors affecting MCH care access during the pandemic. While CHWs played a crucial role in mitigating some challenges, systemic issues such as inadequate information dissemination, transportation constraints, and fear of infection created significant barriers. The increased physical and mental strain on women underscores the need for a holistic approach to MCH care, addressing both physical and psychological needs. The study's findings are consistent with other research highlighting the negative impact of the pandemic on RMNCH services, emphasizing the need for preparedness and alternative strategies to ensure continuous access to care during public health emergencies. The results support the need for home-based care models, improved communication strategies, and investment in reliable transportation to improve healthcare access, particularly in rural settings.

This study underscores the significant challenges faced by pregnant women and postnatal mothers in accessing MCH services during the COVID-19 pandemic in Odisha. The pandemic exposed existing vulnerabilities in the healthcare system, highlighting the need for proactive planning and context-specific policies to ensure the continuity of essential MCH care during future health emergencies. Future research could focus on developing and evaluating interventions to address the identified challenges, including improving information dissemination, expanding home-based care services, and enhancing transportation support. Further research is also needed to explore the long-term impacts of the pandemic on maternal and child health outcomes.

The study's findings are based on qualitative data from a specific region in India and may not be generalizable to other contexts. The study is limited to the period of the COVID-19 pandemic and the experiences reported might not be representative of other similar health emergencies. The sample size, while sufficient for qualitative analysis, may not represent the entire population of antenatal and postnatal mothers in Odisha. The reliance on self-reported data introduces potential biases.