Indian Journal of Health Social Work
Impact Of Covid-19 On Reproductive Health Care Services Among Women: A Cross Sectional Study In Select District Of Odisha
Kheyali Roy1 & Shaurya Prakash2
1-2Research Scholar, Department of Social Work, Visva-Bharati, Santiniketan West BengalCorrespondence: Kheyali Roy, e-mail id: email@example.com
Background: The COVID-19 pandemic has wreaked havoc on health systems, led to a global economic shutdown, and upended life as we know it. Sexual and reproductive health needs are often neglected in the midst of an emergency and COVID-19 has been no different. A reproductive health approach recognizes that the foundations of women’s health are laid in childhood and adolescence, and are influenced by factors such as nutrition, education, sexual roles and social status, cultural practices, and the socioeconomic environment. Reproductive health care strategies to meet women’s multiple needs include education for responsible and healthy sexuality, safe and appropriate contraception, and services for sexually transmitted diseases, pregnancy, delivery, and abortion. Aim: To study the impact of Covid-19 on Reproductive Health Care Services among Women in the targeted population of Odisha. Materials and Methods: A cross- sectional mixed study was conducted in Balasore district of Odisha. The researchers used simple random and purposive sampling for this particular study. Employing the statistical formula, with a confidence level 95% and a confidence interval of 5, the required sample size is 385. As the situation is not normal for the pandemic so the researchers have taken 100 women for this study and the data was collected using questionnaire and unstructured interview schedule (telephonic). Results and Conclusion: This paper deals with the knowledge of reproductive healthcare services among respondents and the effect of Covid- 19 on the reproductive healthcare services. It also deals with the effect of Covid-19 on family planning services. Thus, it is very obvious to say that Covid-19 has affected the respondents in terms reproductive healthcare and family planning services.
The COVID-19 pandemic has wreaked havoc on health systems, led to a global economic shutdown, and upended life as we know it. As the virus spreads at alarming rates, the fallout has spanned the globe and revealed the ill- preparedness of governments, health systems, and social safety networks to respond to the longstanding and emerging needs of people worldwide, especially relating to the health and rights of women and girls. While the global response has rightly focused on containing the virus and treating the infected, it has also
illustrated gaps in our existing approach to sexual and reproductive health care and articulated the need to embrace a comprehensive approach to health care long after the crisis ends. As health systems are increasingly strained, sexual and reproductive health care services are often mischaracterized as non-essential or “elective,” and thus de-emphasized with critical consequences. Access to pills has been reduced due to COVID-19. In the United States, where many young women receive contraception on college campuses, the closure of schools has created access challenges. Young girls and women who fulfil their gynaecological needs through their general practitioner could run into difficulty scheduling an IUD installation or hormonal implant as many are limiting in visit. The limitations on in- person visits can additionally create a barrier to oral contraceptives, which require an appointment to acquire a prescription for initial access and subsequent refills. (IWHC, 2020). The Covid 19 pandemic is having potentially catastrophic secondary impacts on the reproductive health of women around the world. Decisions made at every level of the response to the Covid 19 pandemic are resulting in women being further cut off from sexual and reproductive health services, threatening sharp rises in maternal and neonatal mortality. Sexual and reproductive health needs are often neglected in the midst of an emergency – and COVID-19 has been no different. In March, the World Health Organization (WHO) issued interim guidance for maintaining essential services during an outbreak, which included advice to prioritise services related to reproductive health and make efforts to avert maternal and child morbidity and mortality. Nevertheless, as governments, ministries of health, and frontline providers were forced to make tough choices about which services are most important, women were often left out. Resources for women’s healthcare were sometimes diverted to support COVID-19 activities. (Medicines Sans Frontiers, 2020).
The Pandemic Covid -19
On 11 March 2020, WHO declared Novel Corona Virus (COVID-19) outbreak as a pandemic and reiterated the call for countries to take immediate actions and scale up response to treat, detect and reduce transmission to save people’s lives. (WHO, 2020).
With a massive surge of 8,386 new cases in the last 24 hours Odisha is all set to enter the explosive phase of the Covid-19 pandemic that will add more pressure to the already over- stressed healthcare system. The State has reported over 8,000 cases for the first time since the pandemic. We are closely monitoring the situation and ramping up health infrastructure
in view of the rising cases. Districts have been asked to go for localized micro containment zones in case clusters emerge. People need to cooperate, stay at home. (Rout, 2021).
Reproductive Health Care Services
Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. (WHO). Reproductive health services are a part of our holistic approach to empowering the most vulnerable communities to address the root causes of poverty and injustice. (Lopez, 2020). A reproductive health approach recognizes that the foundations of women’s health are laid in childhood and adolescence, and are influenced by factors such as nutrition, education, sexual roles and social status, cultural practices, and the socioeconomic environment. Reproductive health care strategies to meet women’s multiple needs include education for responsible and healthy sexuality, safe and appropriate contraception, and services for sexually transmitted diseases, pregnancy, delivery, and abortion. (Sai, Nasim, 1989).
In order to overcome the barriers faced by the women of Odisha it is important to improve the access to services so that they get them easily. Some of the imperative actions such as strengthening community mobilization through inter-personal communication, dialogue with the key influencers in the community as well as continuous engagement with and sensitization of the service providers. (Sahoo, Som, Pradhan, 2017). Utilization of maternal healthcare services which is the key to combat the maternal morbidities or death is low and unevenly distributed among different subgroups in Odisha. This is more noticeable in the disadvantaged regions among the poor and illiterates. The distribution of services thus needs to be strengthened, especially among the socioeconomically disadvantaged groups and regions. Up gradation of health infrastructure including positioning skilled health personnel in public health centers in rural and disadvantaged regions can be the main priority in the health planning and programmes. Large scale healthcare awareness programmes in addition to promoting female literacy are pertinent to enhance the maternal healthcare seeking behaviour in Odisha.(Prusty, Gouda, Pradhan, 2015).
Covid- 19 & Reproductive Health Care Services
The COVID-19 pandemic and strict lockdown in India have affected reproductive services such as maternal health, family planning, and abortion services adversely. While medical facilities and retail chemists were exempted from the lockdown, the curbs on movement, as well as enhanced fear of infection among patients and health providers, resulted in low availability of services. So, while the Government of India deemed RMNCAH+N (Reproductive, Maternal, New-born, Child, Adolescent Health and Nutrition) services as essential in mid-April, access and availability continued, and continues, to be a big challenge. (Motihar, 2020). There are many factors that affecting the use of essential health interventions during the Covid – 19:
- Health facility capacity taken up by Covid–19 cares
- Redeployment/ Morbidity/ Mortality of health care workers
- Supply chain disruptions
- Movement restrictions
- Lost in income
- Concerns about Covid – 19 transmissions
To study the impact of Covid-19 on Reproductive Health Care Services among Women in the targeted population of Odisha. The researchers have also some specific objectives of this study which are to know the knowledge about reproductive health care services of the targeted group, to assess the barriers to utilisation of the reproductive health care services and to understand the magnitude of the Covid-19 pandemic over the reproductive healthcare services in the study area.
MATERIALS AND METHODS
This section includes the particulars about the methodology that has been acquired to carry out the present study. It encloses details on research design, study area, selection of sample and size, study variables, research tools, conduct of study, data collection and statistical analysis.
Sample of the Study
Women in the age group of 19-27 years of Balasore district were the sample for the study. Women were selected from rural and urban areas of Balasore sub division.
The researcher used simple random and purposive sampling for this particular study.
The total female population of Balasore district is 1,133,048 (Census, 2011). As there are no specific data for the mentioned age group for this study the researchers have taken the total female population. Employing the statistical formula, with a confidence level 95% and a confidence interval of 5, the required sample size is 385. As the situation is not normal for the pandemic so the researchers have taken 100 women for this study.
In accordance with the objectives of the study, it was important and crucial to assess the awareness and attitude of women towards reproductive health and to know the impact of Covid 19 in the reproductive health care services among women in the study area. Women are distinct population group with particular needs and capacities. To fulfil the research, aim and objectives the researchers have adopted and conducted the cross-sectional study.
One of the most usual research designs is the cross-sectional study design. In this type of research study, either the entire population or a subset there of is selected, and from these individuals, data are collected to help answer research questions of interest (Olsen and St. George, 2004). Cross-sectional studies are very useful from reproductive health research point of view. This study design can provide a picture of the impact of Covid-19 on reproductive health care services in a population of different age groups and measure the risk factors associated with it of women. The researchers analysed the study through both qualitative and quantitative data. Thus, the researcher adopted the mixed method of research design for the fulfilment of the research objective of this particular study.
The researchers selected the district named by Balasore in the state of Odisha as the study area. The population of Odisha is 42 million in which youth constitute one fifth of its population. The state has achieved the goal of reaching TFR of 2.1. However, the unmet need for family planning continues to be high at 19%. The modern contraceptive prevalence rate in Odisha is 46.3 percent (NFHS, 2005). Among the states of India, Odisha has the fourth highest MMR (222) (GOI, 2013) and third highest IMR (49) (GOI, 2016). One quarter (25.9 percent) of currently married women aged 15 – 49 years were married before the legal age of 18 years in the state with 7.2 percent teenage births (GOI, 2013). The family planning programme needs to take into consideration the population composition and address the growing demand for spacing methods in addition to services for limiting. Balasore is one of the coastal Districts of Odisha. It lies on the northern most part of the state. It was a part of the ancient Kalinga which later became a territory of Toshal or Utkal, till the death of Mukunda Dev. Balasore as a separate District was created in October 1828. Originally it was in Bengal presidency. Balasore District covers an area of 3634 sq. kms having total population of 23, 17,419 as per 2011 census. The district is surrounded by Medinipur District of West Bengal in its northern side, Bay of Bengal in its east, Bhadrak District in its south and Mayurbhanj and Kendujhar Districts lies on its western side. The district is located at 20.48 to 21.59 North Latitude and 86.16 to 87.29 east Longitude. Total male population of the district is 11, 84,371 and female population is 11, 33,048 as per 2001 census. (Gov. of Odisha, 2021).
In this section the researchers have tried to analyse the collected data through Google forms and telephonic interview by using various statistical technique. The researchers divided the sample size in to three groups. The following table shows the different number of participants in various age group in this study.
Table: 1, it can be said that the age distribution of the respondents is 19-21, 22-24 and 25-27 and the number of respondents from each category are 47,30 and 23 respectively.
Results from hypothesis
H1 – age group may influence the knowledge about reproductive healthcare Services.
H0 – age group may not influence the knowledge about reproductive healthcare Services.
÷2 = 3.787
Degree of freedom = 4
The critical value of ÷² at 5% of level of significance at 4 degrees of freedom is 9.487 and calculated value of ÷² at 5% of level of significance at 4 degrees of freedom is 3.787. So, the null hypothesis is accepted and the research hypothesis is not accepted.
Thus, it can be concluded that the age group may influence the knowledge about reproductive healthcare Services.
The findings accepted the null hypothesis and rejected the research hypothesis. Thus, it can be concluded that the age group may influence the knowledge about reproductive healthcare Services.
Table-2 clearly shows the percentage distribution of the respondents involved in study, job, entrepreneurship and household works.
Impact of Covid-19 on the Knowledge of Reproductive healthcare Services
There are many government programmes about reproductive health and to increase the level of knowledge and awareness about reproductive health. As the pandemic disease change the daily life of each and every section of our society, impacts very much on the reproductive health domain also. The women are stake at home and they are not availing the resources to increase their level of knowledge about reproductive health. The data showed that the women in the age group of 19-21 are in the more vulnerable position as the educational institute were closed from nearly about 2 years. The main source of knowledge providers are the teachers, the peers, the health educators and the health facilitators. The Covid- 19 restrictions stop all the providers to make aware about reproductive health among the women.
From the data given by the respondents the researchers have come to know about the result shown in the below chart.
From the above table-3 the level of knowledge about reproductive healthcare services among various age groups can be easily outlined.
The figure-1 represents the level of knowledge about reproductive healthcare services among different age groups.Menstrual hygiene and practices
Menstrual health is a key determinant of reproductive health. The women should have proper knowledge about menstrual health and hygiene. The wrong practice of menstruation often causes death also. So, it is important to have proper knowledge about menstruation. Many of the women still are not aware about the disease that are caused by the wrong practice of menstruation. So, the health care providers give counselling to the women in various government and private health sector. The Covid-19 restrictions also influence these services by the fear of its contamination, lockdown restrictions and the economic instability caused by this pandemic.
Marital status of the respondents
The researchers have mentioned the marital status of the respondents as the research related to reproductive health care services and the age group of this study is 19-27 years of age so to know the marital status of the respondents is important for the need of this study. The research data showed that married population is proportionally high with the increase of age group.
Table: 4 represents the marital status of the respondents i.e., 22 respondents from age group of 19-21 are married, 19 of the respondents from age group of 22-24 are married and 18 of the respondents from age group of 25-27 are married. Similarly, 25 respondents from age group of 19- 21 are unmarried 11 respondents from age group of 22-24 are unmarried and 5 respondents from age group of 25-27 are unmarried.
Family planning services
The government of Odisha planned many programmes and also provide human resource for family planning services. Family planning is a core component of reproductive healthcare services. It is very important that women have a clear idea about family planning. The Covid-19 restrictions and the fear about the contamination of that particular disease the majority of the women are avoided to step out from home. So, the group of women are not in touch of the health care providers and the health facilitators. This leads to low knowledge and misconception about the reproductive health and the related factors. Counselling service is very much needed for the family planning services which is break down for the Covid-19 restrictions and women also avoid it for the Covid-19 pandemic.
The figure 2 shows the impact of Covid-19 in family planning service i.e., 15 are from the age group of 19-21, 20 are from the group of 22-24 and 65 are from the group of 25-27.
Pregnancy and delivery related issues
Many women die due to complications and less knowledge about pregnancy and delivery related issues. The proper knowledge about reproductive health also affects the maternal health among women. The fear of Covid-19 disease compelled the people not to step out from the home and this affects the pregnancy and delivery related issues. Majority of the respondents revealed that Covid- 19 affects the maternal health also.
Due to the effects of COVID-19 pandemic on society, which have caused problems such as social isolation, unemployment, economic problems, staying at home, and depression, they can affect the couple’s relationships. During this pandemic, the health attention has been focused on COVID-19, respiratory tract, personal protective equipment, and protection against the virus, and very little attention has been paid to the sexual and reproductive health of men and women. This can pose significant challenges for both health care providers and women and men of childbearing age. (Alizadeh, Ozgoli, 2020). Many places have seen decreased access to and increased violations of reproductive healthcare services during the COVID-19 pandemic. Places with severe restrictions on abortion seem less likely to have implemented changes to reproductive healthcare delivery to mitigate this impact. Political will to support the advancement of reproductive healthcare services is often lacking, which is fundamental to ensuring both continued access and, in a minority of cases, the solidification of gains made to reproductive healthcare services during the pandemic.
This research paper deals with the knowledge of reproductive healthcare services among respondents and the effect of Covid-19 on the reproductive healthcare services. It also deals with the effect of Covid-19 on family planning services. Thus, it is very obvious to say that Covid-19 has affected the respondents in terms reproductive healthcare services and family planning services.
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Conflict of interest: None
Role of funding source: None