Exploring Mental Health during the Initial COVID-19 Lockdown in Mumbai: Serendipity for Some Women

Background: This study explored how low-income women already distressed by reproductive challenges were affected during the initial lockdown conditions of the COVID-19 pandemic in Mumbai, India. Methods: Women with reproductive challenges and living in established slums participated in a longitudinal mixed-methods study comparing their mental health over time, at pre-COVID-19 and at one and four-months into India's COVID-19 lockdown. Results: Participants (n = 98) who presented with elevated mental health symptoms at baseline had significantly reduced symptoms during the initial lockdown. Improvements were associated with income, socioeconomic status, perceived stress, social support, coping strategies, and life satisfaction. Life satisfaction explained 37% of the variance in mental health change, which was qualitatively linked with greater family time (social support) and less worry about necessities, which were subsidized by the government. Conclusions: As the pandemic continues and government support wanes, original mental health issues are likely to resurface and possibly worsen, if unaddressed. Our research points to the health benefits experienced by the poor in India when basic needs are at least partially met with government assistance. Moreover, our findings point to the critical role of social support for women suffering reproductive challenges, who often grieve alone. Future interventions to serve these women should take this into account.

Disruptions in maternal and child health service utilization during COVID-19: analysis from eight sub-Saharan African countries

The coronavirus-19 pandemic and its secondary effects threaten the continuity of essential health services delivery, which may lead to worsened population health and a protracted public health crisis. We quantify such disruptions, focusing on maternal and child health, in eight sub-Saharan countries. Service volumes are extracted from administrative systems for 63 954 facilities in eight countries: Cameroon, Democratic Republic of Congo, Liberia, Malawi, Mali, Nigeria, Sierra Leone and Somalia. Using an interrupted time series design and an ordinary least squares regression model with facility-level fixed effects, we analyze data from January 2018 to February 2020 to predict what service utilization levels would have been in March-July 2020 in the absence of the pandemic, accounting for both secular trends and seasonality. Estimates of disruption are derived by comparing the predicted and observed service utilization levels during the pandemic period. All countries experienced service disruptions for at least 1 month, but the magnitude and duration of the disruptions vary. Outpatient consultations and child vaccinations were the most commonly affected services and fell by the largest margins. We estimate a cumulative shortfall of 5 149 491 outpatient consultations and 328 961 third-dose pentavalent vaccinations during the 5 months in these eight countries. Decreases in maternal health service utilization are less generalized, although significant declines in institutional deliveries, antenatal care and postnatal care were detected in some countries. There is a need to better understand the factors determining the magnitude and duration of such disruptions in order to design interventions that would respond to the shortfall in care. Service delivery modifications need to be both highly contextualized and integrated as a core component of future epidemic response and planning.

Inequity in India: the case of maternal and reproductive health

Background

Millennium Development Goal (MDG) 5 is focused on reducing maternal mortality and achieving universal access to reproductive health care. India has made extensive efforts to achieve MDG 5 and in some regions much progress has been achieved. Progress has been uneven and inequitable however, and many women still lack access to maternal and reproductive health care.

Objective

In this review, a framework developed by the Commission on Social Determinants of Health (CSDH) is used to categorize and explain determinants of inequity in maternal and reproductive health in India.

Design

A review of peer-reviewed, published literature was conducted using the electronic databases PubMed and Popline. The search was performed using a carefully developed list of search terms designed to capture published papers from India on: 1) maternal and reproductive health, and 2) equity, including disadvantaged populations. A matrix was developed to sort the relevant information, which was extracted and categorized based on the CSDH framework. In this way, the main sources of inequity in maternal and reproductive health in India and their inter-relationships were determined.

Results

Five main structural determinants emerged from the analysis as important in understanding equity in India: economic status, gender, education, social status (registered caste or tribe), and age (adolescents). These five determinants were found to be closely interrelated, a feature which was reflected in the literature.

Conclusion

In India, economic status, gender, and social status are all closely interrelated when influencing use of and access to maternal and reproductive health care. Appropriate attention should be given to how these social determinants interplay in generating and sustaining inequity when designing policies and programs to reach equitable progress toward improved maternal and reproductive health.