Received: 21 July 2020 Accepted: 7 August 2020

DOI: 10.1002/hpm.3050

LETTER TO THE EDITOR

The coronavirus (COVID-19) pandemic's impact

on maternal mental health and questionable
healthcare services in rural India

Dear Editor,
The outbreak of SARS-CoV-2, the virus causes COVID-19 was first reported in Wuhan, China, in late November/
early December of 2019. Since then, the virus has rapidly spread throughout the world, leading the World Health
Organization (WHO) to declare the outbreak of a public health emergency as an international concern on 30 January
and as global pandemic on 11 March 2020.1 To mitigate the devastating effects of this virus, varying levels of ‘stay
at home’ orders have been implemented around the world. India had announced a complete nationwide lockdown
for 21 days, limiting movement of 1.3 billion population from the midnight of 24 March.2 But this sudden lockdown
has led to unprecedented adversities for several vulnerable groups, including Sexual, Reproductive, Maternal, New-
born, Child and Adolescent Health (SRMNCAH), especially in low- and middle-income countries (LMICs).3 According
to the guidelines of the Ministry of Health and Family Welfare (MoHFW), India, with the second-largest global popu-
lation and more than 2.5 crore pregnancies each year, the provision of SRMNCAH have been categorised as one of
the essential services during this pandemic.4 The country is now in the phase of Unlock 2.0, after four successive
lockdowns from 24 March to 31 May 2020. Looking into the multiple hardships faced by Indian migrant workers dur-
ing this pandemic, on 1st May, the central government permitted the ‘Shramik Special’ trains for returning of migrant
workers back home. This was the crucial time when the entire country especially rural areas were exposed to this
virus.
In the present state of affairs, a small pilot survey has been conducted in Birbhum, West Bengal situated in the
rural part of eastern India. The result is showing a sharp 1.09% increase in the rate of home delivery from March to
May 2020. Inadequacy has also been observed in the case of overall utilisation of Maternal Health Care Services
(MHCSs). At the empirical ground, three doctors, four health workers and three women presently at their antenatal
stage (ANC) and two women in their postnatal stage (PNC) have been interviewed through a semi-structured ques-
tionnaire. The responses are clearly portraying the questionable health care system of rural India and how this dubi-
ous system has traumatised the mental health of would be or lactating mothers. A few major apprehensions are
summarised in the following paragraphs.

1. India, specifically the rural counterpart, is facing an acute shortage of health staff, much below the WHO's bench-
mark, that is, 22.8 health workers per 10 000 populations.3 At present, the doctor population ratio in India is
1:1445, far lower than the WHO's prescribed norm (1:1000); where the rural India has only one-fourth the doc-
tors as compared to urban areas.5,6 The majority of rural health workforce are performing their duties without
proper precautionary measures, that is, personal protective equipment (PPE). Such a situation is raising anxiety
amongst the would be and lactating mothers on fear of being infected.2
2. This depression and anxiety affect one in seven women during the perinatal period, developing risk of pre-
eclampsia, premature birth and low-birth weight.7 Approximately 22% of Indian mothers suffers from Post-
partum Depression (PPD), which also called as ‘baby blues’, disturbing a woman’s ability to take care of her

1626 © 2020 John Wiley & Sons, Ltd wileyonlinelibrary.com/journal/hpm Int J Health Plann Mgmt. 2020;35:1626–1628.
LETTER TO THE EDITOR 1627

baby and herself.8,9 There are few factors which are affecting the maternal mental health during this
pandemic.

• The restriction of physical movement and social distancing demoralising the would-be mothers to give birth in a
societally positive environment.
• Many hospitals have put restrictions on visits of partners and relatives of pregnant women admitted to hospitals
for delivery, due to COVID-19 preventive measures. This is why women in some cases are choosing to deliver
at home.
• Pregnant women may feel social isolation, and have greater fear of infection for themselves as well as their
infants.
• Most of the ambulance services diverted for COVID-19 related activities and women in labour are finding it
increasingly difficult to access MHCSs. Cases of transit deliveries have also been observed during this phase of
the pandemic.
• There is even information about the mental health impacts on pregnant women, living in a household with an
infected person in a containment zone.
• The drastic restrictions on economic activities have led to many instances of suicide among the migrant labours.
Their eventual frustration has led to an increase of cases like- Intimate Partner Violence and induced unsafe
abortion.
• The entire situation has also resulted in underutilization of MHCSs including both ANC and PNC checkups.
• As pregnant women being more susceptible to viral infection, all the health workers have been directed to pro-
vide services through tele-consultation.3 But providing tele-medicine or launching ‘Aarogya Setu’ mobile app to
track spread of coronavirus are nothing but mere eyewash for a country like India where 12.4% people are lying
at the below poverty level, and for basics the daily wage earners are depending on the relief activities done by
Government and different Non-Governmental Organisations. Even in feasible areas of tele-consultation, absence
of face to face interactions with healthcare providers has added to the stress and depression among pregnant
women.
• Cases of unwanted pregnancies during the lockdown and their fatal consequences have become another reason
for mental anxiety among the women. According to the United Nations, over the coming 6 months, 47 million
women in 114 LMICs may not be able to access modern contraceptives, and might bring an additional 31 million
cases of gender-based violence.10

From the above discussion, it can be concluded that pregnant women and lactating mothers are certainly at an
increased risk in this current pandemic. The government should realise that the mere existence of guidelines mandat-
ing adequate care for the pregnant women,2,11 does not guarantee access to the facility; unless and until they intro-
duce space and community-specific programmes. A holistic strategy should be commenced in an inclusive way for
future preparedness. It is worth mentioning here that India's first COVID-19 vaccine, named ‘Covaxin’, got approval
for human trials in the second week of July 2020 by Drugs Controller General of India (DCGI). Expecting its success-
ful completion for the sake of winning the battle with this pandemic.

CONF LICT OF IN TE RE ST
The authors declare no conflict of interest.

Alokananda Ghosh1
Shraban Sarkar2

1
Department of Geography, Tehatta Sadananda Mahavidyalaya, Tehatta, West Bengal, India
2
Department of Geography, Cooch Behar Panchanan Barma University, Cooch Behar, West Bengal, India
1628 LETTER TO THE EDITOR

Correspondence
Alokananda Ghosh, Department of Geography, Tehatta Sadananda Mahavidyalaya, Tehatta, Purba Bardhaman
713122, West Bengal, India.
Email: alokanandaghosh04@gmail.com

ORCID
Alokananda Ghosh https://orcid.org/0000-0001-5107-1085
Shraban Sarkar https://orcid.org/0000-0001-5846-0972

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