Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), and the resulting COVID-19, is a substantial international public health issue. The cases showed a sharp rise in second wave with severe complications. The sudden rise of cases across various nations resulted in many nations announcing lockdowns and travel restrictions [1]. 

The rapid rise of cases in the nation had challenged the health system and also the economy of the nation. Chhattisgarh was also among many states which had got affected by the spread of Covid-19. The cases of covid were noticed in both the waves however the spread was aggravated and took a havoc shape during the second wave. It aggravated across all districts during the second wave with number of positive cases rising [2]. Due to sudden out spurt of cases across all districts the government had to put all efforts to mitigate the after effects such as mortality and morbidity due to covid which resulted in lesser efforts towards sustaining routine health care services [3]. 

COVID-19 demonstrated the world’s vulnerability to infectious disease outbreaks and highlighted the importance of preparedness. It had already devastated the communities, threatening economies, and diminishing quality of life for the people of the State. It was required to study the impact that the disease had put in the overall health systems so that the state can prepare itself from dealing with such situations in future. Among most of the services the maternal health services were also affected during the covid and through this paper will help to understand the effect of covid-19 on maternal health care services such as delivery and post-natal care [4-8].

The study was conducted in the Bemetara district of Chhattisgarh. The method of data collection involved qualitative and quantitative methods of data collection. During the study primary data was collected through in-depth interview of selected respondents. The questions comprised of maternal health seeking behavior in terms of PNC and delivery services adopted by the respondents. The questions were also framed to understand the underlying causes which affected the respondents decisions related to delivery and seeking PNC care. Primary data was collected from the 750 respondents. Respondents were selected from the period 1/04/2020 to 30/11/2020 who had completed the cycle of ANC, delivery and PNC. The questions which were asked to respondents were of semi structured nature and were open ended in nature. The information was collected from each selected beneficiary in the form of one-to-one field level survey with the defined questionnaire. Approach of Systemic random sampling was adopted for the selection of respondents for the study [9].

The data collected from respondents was analyzed to understand whether covid-19 had any effect on services related to delivery and post-natal services. The data was collected on many parameters such as availability of facilities, providers, accessibility, place of delivery, availability of outreach services for PNC examinations, IEC conducted among the respondents on danger signs during post-natal period.

The first parameter which was studied was on place of delivery chosen by the respondents (Table 1).

Table 1: Place of Delivery

The data showed that 65.3% of women opted for delivery in government/trust-based institutions. There were 26.2% of respondents who opted for home delivery where as 8.5% had done the delivery conducted at private/affiliated hospitals. 

The respondents who had opted for home delivery were questioned for the reason for adoption of home deliveries (Table 2).

Table 2: Reasons for Home Delivery

Of the total respondents 60.5% responded that they had opted for home delivery upon the insistence of their elders. There were 37.4% of cases who opted for home delivery out of the fear from covid. About 2.1% had to opt for home delivery due to financial matters (Table 3). 

Table 3: Factors Affecting Place of Delivery

The factors which affected the choice of place of delivery were also studied

The quality-of-service availability was one of the major parameters to opt for the chosen place of delivery. About 62.1% respondents said quality of services was main parameter in selection of place for delivery. About 21.4% respondents stressed upon the availability of emergency services as second important criteria for selection of place of delivery. There were 12% of respondents for whom the distance from the home was the main criteria for selection of site for delivery [10-12]. 

The parameters which were studied on PNC services were regarding availability of PNC services, IEC conducted to identify danger signs during PNC period and factors which affected availing PNC services. 

The parameter on availability of PNC services during covid was studied. The respondents were divided upon when after the delivery they got their first PNC checkups (Table 4).

Table 4: Status of PNC Services in Covid

The availability of PNC services were affected during covid. 41.3% of respondents got their first PNC checkup between 7-14 days of delivery. There were 16.6% of respondents who got PNC checkups after 2-7 days of delivery and 14.6% got their first PNC checkup after a month of delivery. 22% of respondents got their first PNC checkup after 14 days of delivery. There were only 5.5% of respondents who got their first PNC checkup within 2 days of delivery [13]. 

The nature of difficulty in seeking PNC services was studied. This was done to identify what were the possible reasons due to which the uptake of PNC services got affected (Table 5).

About 56.2% of respondents couldn’t avail PNC services due to the fear of contracting covid-19.

Table 5: Nature of Difficulty in Seeking PNC Services

There were 23.1% of cases who were not aware of places where the services were available. About 14.5% of cases had issues with relation to transportation and accessibility and for 6.2% of cases providers were unavailable. 

The factor on awareness regarding danger signs during PNC period was also studied among the respondents (Table 6).

Table 6: Knowledge Regarding Danger Signs during PNC

The awareness generation activities through outreach services regarding PNC was studied. Around 23.2% of respondents informed that they have awareness regarding danger signs. There were 45.8% of respondents who had partial knowledge regarding danger signs during PNC period and 31% of cases lacked awareness about danger signs during PNC period.

The utilization of PNC services and the institutional delivery was affected during covid-19. The study found that after the onset of covid -19 institutional delivery was affected as their were 26.2% of deliveries being done at homes [14]. The availability of services at government and trust hospitals were maintained which resulted in 65.2% of deliveries being done at government hospitals & trust .the decision of home delivery was primarily being taken on peer pressure which was a result of fear for contracting covid-19. The place of delivery was affected by many parameters but most important consideration by respondents was on quality of services being provided. It had been noticed that the timing of PNC was severely affected due to covid which actually delayed the first PNC checkup among the respondents. 41% of cases had got their first ANC between 7-14 days after delivery [15]. Majorly the reason for delay in seeking timely PNC services were due to covid-19. The outreach services were also affected during covid as 45.8% of respondents had partial knowledge of danger signs during PNC period. The areas of concern which came out from the study should be considered for planning of activities for future such epidemics and pandemics. Moreover there is a need for ensuring that regular activities should not get hampered due to emergencies.

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