COVID-19 status and utilisation of essential maternal and child healthcare services during the pandemic in Ahmedabad, India | BMC Pregnancy and Childbirth

The mixed-method approach was carried out in Ahmedabad, Gujarat, India. The study was conducted from November 2021 to October 2022.

Study setting

Ahmedabad is a city in the west of India. It is the 5th most populous city in the country and the most populous city in Gujarat. The Forbes list ranked it the third fastest-growing city of the decade in 2010. The whole city of Ahmedabad has been divided into 6 Administrative divisions: Central, East, West, North, South, and North West zones. Ahmedabad is managed by a corporate body called Ahmedabad Municipal Corporation (AMC). The health department of AMC is responsible for managing the city’s health system.

Ahmedabad, a city with a rich historical past, has faced and overcome significant public health challenges. It had a history of several outbreaks in the recent past, like Crimean-Congo hemorrhagic fever (CCHF), Avian influenza (H5N1), Rabies, chikungunya, and zika, among others. Evidence of the city’s ability to manage epidemics throughout its history provides a strong foundation for addressing contemporary healthcare needs. However, the city’s rapidly growing population presents a significant challenge in ensuring all its residents’ access to quality healthcare services.

Study design

It is a mixed-method study involving quantitative and qualitative data collection methods from April to June 2022. The quantitative data was collected through a cross-sectional survey, whereas the qualitative data was collected through the narrative study using in-depth interviews. The quantitative arm estimated mothers’ utilization of ANC, INC, PNC, and immunization services during the pandemic and child healthcare services. A cross-sectional survey among pregnant women or delivered during the pandemic was conducted to gather information on the utilization of maternal and child healthcare services. The qualitative arm was carried out to explore the experience of using maternal and child healthcare services during the pandemic through narrative study. In-depth interviews of pregnant women who delivered a baby during the pandemic were conducted to document their experiences.

Study samples and sampling

Four zones were purposefully selected from the 6 zones in Ahmedabad. In the first stage, each zone was considered a cluster. About 04 healthcare facilities were randomly selected in the second stage from each cluster to represent the city with consideration of the diversity. In the third stage, out of all eligible women per healthcare facility who provided consent, they were recruited for the study. Fifty women per healthcare facility per cluster was the initial targeted sample size. Women who had their delivery at a government or a private facility during the pandemic and were residing within the city were included in the study, whereas the women who didn’t deliver due to abortion or had a miscarriage or migrated were excluded from the study.

Quantitative assessment

The quantitative assessment was carried out among women who were pregnant or had delivered during the pandemic. The women who provided consent were selected from the total list of eligible women who delivered or were pregnant from April 2020 to October 2021. About 278 women were recruited for the quantitative assessment, irrespective of their COVID-19 infection status.

Qualitative assessment

IDIs were carried out among ten mothers who had delivered during the pandemic, irrespective of their COVID-19 infection status. The mothers were selected purposively to document the diverse delivery experiences.

Operational definitions

1. 1.

   COVID-19-positive mothers: The women who were pregnant or delivered a baby during the pandemic but were exposed to the Sars-CoV2 virus and tested positive during their pregnancy.

2. 2.

   COVID-19-negative mothers: The women who were pregnant or delivered a baby during the pandemic but never tested positive for the Sars-Cov2 virus during their pregnancy.

Data collection

Quantitative data collection

The quantitative information was collected using a structured survey questionnaire. The information sought concerned such data as basic demographic details about ANC and PNC services and reasons for not availing of the services The details like demographic details, details on reproductive history like the parity, gravida, type of delivery, place of delivery, services that were availed as part of ANC, INC, and PNC, services availed during childcare, and reasons for not availing were explored and included in the data collection tool. The data were collected in the vernacular language by the trained researchers.

Qualitative data collection

The qualitative information was collected using a semi-structured interview guide by the trained researchers in the vernacular language. The semi-structured interview guide was designed to capture detailed information about their experiences during pregnancy, issues, and challenges faced during the delivery due to the pandemic, and issues in obtaining PNC and child healthcare services. Each interview was for about 30 to 45 min.

Data analysis

The quantitative and qualitative data were analysed separately and triangulated for interpretation. The following procedures were used for the analysis.

Quantitative analysis

Once the data was collected, data sets were prepared and validated in Microsoft Excel. Following that, data was cleaned and analysed using the statistical software STATA version 14.1.

• Dependent Variable: Status of COVID-19 (COVID -ve mothers vs COVID + ve mothers)

• Independent Variable: Socio-demographic factors, Maternal healthcare (ANC, INC, and PNC) services, and Child healthcare services

A descriptive analysis of the basic socio-demographic details was carried out. The bivariate analysis was out conducted to assess the difference in utilization of ANC, INC, PNC, and child healthcare services during the pandemic between women who tested positive for COVID-19 and those who didn’t test positive for COVID-19. A chi-square test was conducted to observe the statistical significance. Binomial logistic regression analysis was performed to evaluate the differential utilization of these services in relation to their status of COVID-19. The COVID-19-negative mothers were considered as an outcome of interest as compared to the positive mothers to understand the reach of healthcare accessibility.

Qualitative analysis

Firstly, all the recorded audio was transcribed and then translated into English. Then, the thematic analysis was done, and the data was coded based on that. The data analysis involved various team members to ensure reliability, reproducibility, and stability. A deductive approach was used to understand the healthcare availability and accessibility challenges experienced by the recruited women. In the result section, significant quotes were shown under two prime thematic domains, i.e., social and health system determinants for the disparity in the utilisation of services during the pandemic.