Introduction:

Bangladesh witnessed devastating effect on the health care system due to COVID-19 pandemic and the situation became the worst in case of pregnant women (Cohut, 2020). Pandemic hit the people from low-income households most, especially the pregnant women. Since the cities over the country were locked down due to COVID-19, doctors and medical practitioners are not available always at the medical centers in case of medical emergency. The medical services are provided by midwives through telephone. The unavailability of maternity services leaves women with increased number of unskilled home deliveries (BRAC, 2020). By disrupting the maternity care, COVID-19 influences the situation of pregnant women that prompt the risk of poor health status of mother and child (Gildner and Thayer, 2020). Again pandemic infuses some new types of stress like contact to Coronavirus, inadequate staff and separation from family which are complicating the delivery process. The government of Bangladesh is struggling with the pandemic situation with the existing health care system and logistics resulting downward maternal and other reproductive health services, including family planning (UNFPA, 2020).

Statement of the Problem:

Pregnancy, childbirth and postnatal state are the periods which is combined called maternal health and it is a very critical period in a woman’s life (WHO, 2018). Complications during pregnancy are a common experience for mothers in Bangladesh as traditionally women get married at an early age (WHO, 2015). COVID-19 has left lot of peoples either sick or is being killed and this is slowing the global economy (Haleem et al., 2020). Globally, 830 women die every day from the reasons related to pregnancy and child birth and 86 percent of pregnant women have the access to health care with skilled medical professionals at least once (WHO, 2018; UNICEF, 2018). There are number of direct and indirect causes behind high maternal mortality rate in Bangladesh. Obstetric hemorrhage is one of the direct causes for one third of all maternal mortality while three-fourths of all deliveries are taken place at home by traditional unskilled birth attendants. Government of Bangladesh introducedcommunity based skilled birth attendant programme to reduce the maternal mortality rate (Roy and Shengelia, 2016). As Bangladesh achieved a great headway in maternal health development through the changeover from MDGs to SDGs but still struggling to cope with structural barriers and challenges including improper implementation of policy, bureaucracy induced delays, lack of proper infrastructure and good health governance that obstruct the process of improved maternal and child health condition in broader level (Khan, 2017).Antenatal and postnatal health services have been decreased and deliveries in medical facilities have decreased by 21 per cent from January to March 2020 compared to October to December 2019. Some 56,700 more maternal deaths could also occur in just six months, in addition to the 144,000 deaths that already take place in the same countries over a six-month period (UNICEF, 2020).

Restricted entry, transportation problem and anxiety of transmitting Corona virus are the most faced barriers in accessing to maternal health care due to pandemic. Women sometimes prefer not to go to hospitals or clinics for the fear of getting infected with virus and transmission of it to the babies. Problem of transportation facilities and unavailability of timely care due to COVID-19 are the contributing factors for increasing maternal mortality (Pant et al., 2020). The causes behind the increasing maternal mortality there is ‘three delay’ model is commonly used. Delay in decision making to health service, delay in reaching medical centers and delay in accessing required medical care (Calvello et al., 2015). Due to lockdown there is already decreased supply of nutritious food and pregnant women are deprived of the micronutrient supplements of the clinics (Pant, et al. 2020). This three delay model is adversely influenced by the pandemic situation. Reproductive, maternal, newborn and child health (RMNCH) services including the pharmaceutical and medical supply chain have been disrupted by the pandemic situation and response to the pandemic situation (Roberton, et al., 2020).

Ensuring proper maternal care is a global challenge now. Women are more vulnerable to the consequences of pandemic situation than men because of the susceptibility to seek antenatal care, child birth and post natal care in existing health care system. Special attention should be given to pregnant women and newborns as they are more vulnerable clinics (Pant, et al. 2020).

Objective of the Study:

The major objectives of the study are:

a) To explore the socio-demographic and economic situations related with maternal

health seeking behavior of the participants during COVID -19;

b) To investigate the nature of the antenatal and postnatal care seeking behavior;

c) To find out the effect of COVID -19 on the existing services provided for antenatal care and post natal care as well as overall maternal health.

Research Questions:

• What are the problems the pregnant women are facing in this pandemic?

• Whether infrastructural supports are sufficient or not?

• During COVID-19, are they considered having medical services more throbbing

Review of Literature:

Robertson T. et al (2020) in their study estimated the impact of potential disruption of health systems and decreased access to food due to COVID-19 resulting into the additional maternal and under-5 child deaths. Authors sought to reflect emerging reports of the supply-side and demand-side effects of the pandemic. They modeled three scenarios and used the Lives Saved Tool (LiST) to estimate the additional maternal and under-5 child deaths under each scenario in 118 low-income and middle-income countries. They found that disruption in health care service and the decreasing amount of food resulted from unavoidable shocks, health system collapse, or intentional choices made in responding to the pandemic can cause the increased rate of child and maternal deaths. In their study they pictured the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries by modeling.

Schwartz, D. A. and Graham, A. L. (2020) discussed about the spreading corona virus rapidly throughout the world through infected persons travelling by air, eventually reachingmultiple countries and continents and via natural aerosols from human-to-human. According to their study a limited number of women experienced Corona virus infections during their pregnancy. They reviewed the published data addressing the epidemiological and clinical effects of SARS, MERS, and Coronavirus infections on pregnant women and their infants for the study. Finally they recommended for the concern of pregnant women in the design, clinical trials, and implementation of future 2019-nCoV vaccines.

Sochas, L. et al. (2017) tried to estimate the application of essential reproductive, maternal and neonatal health services in Sierra Leone during the Ebola outbreak. They used interrupted time-series regression to analyze Health Management Information System (HMIS) data and modelled the decreased implications in terms of excess maternal and neonatal deaths, as well as stillbirths by using the Lives Saved Tool. They found the largest decrease in antenatal care coverage as a result of the Ebola epidemic and estimated 22 percent decrease in population coverage compared with the most conservative counterfactual scenario. They reported the decreased utilization of family planning, facility delivery and post-natal care services alsodecreased but to a lesser. They identified that the indirect mortality effects of a crisis lacking resilience is not less important than the direct mortality effects of the crisis itself.

Pant S. et. al. (2020) in their study assessed the effect of COVID-19 on access to Maternal Health Service (MHS). National and international reports on maternal health services during COVID-19, and journal articles were reviewed for this study. They found that women worldwide are facing more obstacles to accessing maternal health care including restrictions, transport challenges, and anxiety of being exposed to coronavirus. Many women preferred not to seek healthcare due to the fear of transmitting the virus to their unborn babies. Movement restriction is another challenge for pregnant women to get health care facilities. Even who managed to reach health centers has reported not receiving timely care. Eventually These all are resulting into considerable increased maternal mortality globally over the next six months. Number of efforts has been made to lift maternal health in both developed and developing countries. This pandemic has highlighted the importance of health preparedness with special attention given pregnant women and newborns while planning for such events.

Sarwar, A. et al (2020) found that the current pandemic delayed routine follow-up at medical centers, scheduled labor inductions and cesarean sections. Limited supplies of personal protective equipment have spread anxiety among medical professionals that resulted in the interruption of routine checkups. Throughout the world as health systems are being prepared to deal with the SARS-CoV-2 outbreak which will eventually affect the management of HIV, mental health and mainly maternal healthcare systems. A little concern was expressed over the effects on maternal health services. In the finding they showed that the growing COVID-19 outbreak has increased tremendous pressure on healthcare departments worldwide.

Jiang, H. et. al. (2020) in their study aimed to explore the mental well-being and major approaches of obtaining antenatal health information and the association with perceived stress, anxiety, depression among pregnant women of China in COVID-19 epidemic. They conducted an online survey and tried to find out the occurrence of experiencing perceived stress, anxiety and depression among pregnant women. They found that Hospitals’ official accounts in social media platforms WeChat and Weibo were used as the most popular networks for pregnant women to get health care information. The access to antenatal care services through hospitals official social media accounts was of lower risk of suffering from stress. Social media platforms could be an effective way to mitigate mental health disorders by containing specific contents for pregnant women on how to cope in emergency and major disease outbreak .

Adelaja, L. M. (2011) aimed to describe the home delivery and newborn health care practices and to assess the reasons for delivering at home. Author conducted a cross-sectional survey in the immunization clinics of Sagamu local government, Western part of Nigeria during January and February 2008 and where two trained health workers administered a semi structured questionnaire to the mothers who had delivered their baby at home. Findings of their study depict that majority of the newborns were given a bath soon after birth, rates of breast-feeding were 65.3% within one hour and 95.7% within 24 hours. They concluded that High-risk home delivery and newborn care practices are common in semi urban population also. They recommended community-based interventions to improve the number of families accessing health facilities and engaging a skilled attendant and hygiene during delivery.

Rationale of the Study:

The whole world is observing an obnoxious experience regarding the influx of noble Corona virus. With the increasing rate of transmission of COVID-19, government has declared the safety rules and showed acuteness in following those instructions. It is really tough to go out for a woman in search out of medication in such a situation. In addition, they are to go under a heavy pressure of public transport. Again, due to lockdown and ongoing pandemic, on an average people are not inclined to take medication from doctors rather they search traditional system of healing. The staffs of hospitals and community clinics are not so interested in dealing the patients considering the possibility of transmission of noble Corona virus. However existing services may not realize the respective patient’s demand because of emerging new symptoms of diseases. As the number of death is increasing gradually(average 30 per day) ; in no way it can be controlled and world is not observing any advancement regarding the invention of vaccine against this Corona virus, thus the pandemic is making a huge space for us to study. From another perspective, it has been noticed that the people who are more susceptible to noble corona virus are either aged or vulnerable in health condition (i.e. suffering from diabetes, high blood pressure, heart diseases, pregnancy related complication etc).

Scope of the Study:

Thousands of Corona transmission cases are brought into being everyday with horrible number of deaths. Pregnant women are more prone to be at risk as they are physically nimble with less preventive antibody. Maternal mortality and morbidity is going all the same as before. Again, lockdown has added to a new dimension in having the services available. In Bangladesh, antenatal care 4+ visits percentage of women (aged 15-49 years) attended at least four times during pregnancy by any provider is 37 percent in 2018 (Demographic and Health Survey Key Indicators Report -2017-2018) and 36.9 percent is followed in 2019Multiple Indicator Cluster Survey-2019). As there is no prohibition on marriage, the process of contraception is going on and on. However, one of the focal point of marriages is to procreation of the children. It could be incorporated in policy formulation to consider the ongoing problems of mothering during this pandemic situation.

Methodology

Types of research

This is both descriptive and explanatory in nature.

Study design

A non-experimental research design will be executed following survey method.

Study Area

The study area will be carried out in Sachibunia and Raingamari villages under Batiaghata upazila of Khulna district.

Sampling procedure

Unit of analysis

The unit of analysis will be the attributes of

i) Those pregnant women who are 20 to 45 years old

ii) Having a period of pregnancy for at least 8 months and onwards

iii) Given a successful parturition period iv) currently living with her husband and so on.

Census

A household census will be carried out to have the exact numbers of population in the study area.

Sampling and Sample size determination:

Simple random sampling will be used to conduct the study. After conducting the household census following the attributes of the units, the sample size will be determined. Primarily the approximate sample size is 400.

Techniques of data collection

For this study, interview technique will be followed.

Field work

Primary data will be collected during September ‘21 to December’21 by 5 trained up data collectors who have minimum bachelor degree in sociology.

Data processing and analysis:

After collection of data, it will be processed. Then processed data will be analyzed and interpreted by using descriptive as well as inferential statistical techniques by SPSS. Some statistical tests will be run like regression analysis, correlation, & chi-square test to identifythe relationships between/among the variables. All relevant statistical tests will be done at both significant level (P < 0.05 & P < 0.01).

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