Challenges Faced by Pregnant Women and Postnatal Mothers in Seeking MCH Care During the COVID-19 Pandemic in Odisha, India

The study addresses how the COVID-19 pandemic disrupted maternal and child health (MCH) service utilization among antenatal and postnatal mothers in Odisha, India. Prior reports documented substantial reductions in routine MCH services during the pandemic (e.g., decreases in tetanus toxoid immunizations, institutional deliveries, and postnatal visits) driven by mobility restrictions, fear of infection, staffing shortages, apprehension about COVID-19 testing and isolation, and shifting care preferences. Mental health impacts, including heightened anxiety and obsessive-compulsive symptoms among pregnant women, were also noted. Recognizing a gap in understanding patient-side challenges beyond clinical outcomes, this study aimed to explore, through qualitative inquiry, the barriers and experiences of pregnant and postnatal women in seeking MCH care during COVID-19.

Evidence from low- and middle-income countries indicates widespread disruptions to RMNCH services during COVID-19. Reported declines included: TT first and second doses by 38.3% and 59.6%, institutional delivery by 9–20%, and postnatal visits by 13–22%. Cited factors comprised movement restrictions, fear of contracting COVID-19, reduced availability of health staff, fear of testing and isolation if positive, and increased use of private facilities. Studies also reported increased anxiety and obsessive-compulsive symptoms among pregnant women and adverse impacts on women’s overall health. Much of earlier COVID-19 obstetric research focused on clinical dimensions, leaving limited qualitative insights into lived challenges in accessing care, which this study seeks to address.

Design: Explorative qualitative study conducted in Odisha, India, February–April 2021. Sampling frame: To maximize variance, two districts were randomly selected from each of the three revenue divisions (northern, central, southern), and two blocks were randomly selected per district. From each selected block, one CHC, one PHC, and one subcenter were included to identify participants. Participants: Purposively selected antenatal and postnatal mothers from the selected facilities/communities. Data collection: 36 in-depth interviews (IDIs) conducted in Odia using predesigned, pretested IDI guides; interviews were audio-recorded with informed consent, and COVID-19 precautions were followed. Data management and analysis: Audio recordings were transcribed in Odia and translated into English. MAXQDA software supported coding and analysis. Three researchers reviewed the code tree and reached consensus on categories, themes, and subthemes. Findings were summarized and narrated. Ethics: Approvals from ICMR-RMRC Bhubaneswar IEC (ICMR-RMRCB/IHEC-2020/043/28.11.2020) and State Research and Ethics Committee, Department of Health and Family Welfare, Government of Odisha (13260/MS, Bhubaneswar/18.06.2020); written informed consent obtained prior to interviews.

Sample characteristics: N = 36; mean age 27.6 ± 2.2 years; 16 (44.4%) antenatal and 20 (55.6%) postnatal; 19 (52.8%) primipara and 17 (47.2%) multipara. Two main themes emerged. Theme 1: Access to MCH services during the pandemic. - Support from CHWs: Participants widely reported CHW-provided doorstep services, including health assessments, counseling, iron and calcium supplementation, take-home rations (e.g., cereals/pulses mix, eggs, rice, dal), and medication refills. - Gaps at community level: Some women reported not receiving nutritional supplements at Anganwadi centers or at home and lacked information about community-based services (e.g., VHND schedule and locations). - Mobility and transport barriers: Lockdowns and suspension of public transport limited facility access. Police permitted movement when medical papers were shown, but many had to hire private autos with high fares, creating financial barriers and resulting in missed checkups. - Facility-level barriers: Long waiting times despite appointments (often 1–2 hours) and fear of exposure at crowded facilities. - Preference for home delivery: Some women opted for home delivery due to fear of infection, inaccessible facilities, and transport unavailability. Theme 2: Impact on life of MCH care recipients. - Increased physical strain: Household workload rose with family at home and intensified cleaning due to infection concerns. - Fear and anxiety: Pervasive fear of contracting COVID-19 during pregnancy, childbirth, and concern for newborn safety at hospitals. - Social disruption: Reduced socialization and caution even with family members. - Financial burden: Loss of income due to inability to work, coupled with increased out-of-pocket costs for transport, medicines, and diagnostics during pregnancy. Overall, while CHWs buffered service disruption through home-based support and ensured immunization continuity, gaps persisted in routine ANC/PNC, nutrition services, transport, and information dissemination.

Findings illuminate multifaceted barriers to MCH care during COVID-19: logistical (mobility restrictions and transport shutdown), informational (lack of clarity on VHND schedules and where/when to seek services), psychological (fear and anxiety), and economic (income loss and increased OOP expenditures). These barriers contributed to reduced ANC/PNC visits and home deliveries. Consistent with broader literature, the study underscores mental health strains and service access challenges. Notably, participants reported maintained immunization services due to prioritized programming and adaptive local strategies, contrasting with reports of broader immunization declines elsewhere. The demonstrated role of CHWs in delivering home-based services, counseling, and commodities mitigated some disruptions. Implications include integrating mental health support into ANC/PNC, proactive communication strategies to rebuild trust and inform care pathways, transport facilitation during lockdowns, and leveraging teleconsultation and home-based care models to sustain essential MCH services during emergencies.

During the COVID-19 pandemic in Odisha, MCH care seekers faced compounded barriers—mobility restrictions, transport limitations, fear of infection, and inadequate information—leading to missed ANC/PNC and, in some cases, home deliveries. Beyond physical health, women experienced significant mental stress, anxiety, and social disruption, along with financial strain. Health systems must concurrently sustain routine MCH services while implementing pandemic mitigation, including clear communication, transport support, infection prevention measures, telehealth, and strengthened CHW-led home-based care. Further research should inform context-specific strategies to ensure resilient, high-quality MCH services during future health emergencies.

- Qualitative scope limited to MCH services and the COVID-19 period; findings should be interpreted within this context. - Participant pool largely from rural areas; results may differ in urban settings. - Although a wide geographic spread across divisions, districts, and blocks was used to enhance representativeness, generalizability remains context-bound to similar settings.