COVID – 19 and pregnancy related anxiety

20 July 2020

Pregnancy related anxiety has shot up because of COVID and needs to be recognised and addressed.

The number of people with COVID – 19 continues to spike in India. The Hindu (www.thehindu.com) reports that the number of people who have tested positive for the coronavirus has been nearly 2000 a day for three days straight. The Health Department has confirmed 408 COVID – 19 related deaths so far in the state. Krishna district where Kushal is present has been hit hardest with a 3.17% death rate. Not surprisingly, COVID - 19 anxiety in pregnancy has sky rocketed in Andhra Pradesh.

Communities in Andhra Pradesh are concerned. In ordinary circumstances, perinatal mood and anxiety disorders are among the most common complications that occur in pregnancy or in the first 12 months after delivery (The American College of Gynaecologists and Obstetricians). And these are unprecedented times.

Our beneficiaries are worried, and there is little recourse to advise and comfort because of strict lockdown being enforced.  Antenatal services have been stripped resulting in limited access to information and education. Kushal India is proactively filling the gap by responding to requests with urgency and using digital technologies to surpass these barriers.

Poorer communities are affected the most. All Anganwadi Centres in the state where women from disadvantaged communities generally access government antenatal services have been shut down. We are supporting the local health department to reach out to 700 pregnant women who are linked to urban health centres on their mobile phones with counselling and befriending sessions.

A difficult question colleagues working in the front line are increasingly facing these days is -

“Amma, if I get infected, can I pass the coronavirus to my unborn baby? Will that lead to my child having problems or deformities in the future? My mother-in-law has suggested that I should terminate my pregnancy.”

Difficulty in accessing reliable information and having to take recourse on attention grabbing headlines in the media has spread misinformation and consequently led to fear and panic in communities. Most of our beneficiaries are first time pregnant and young. To have to be under pressure to resort to termination because of myths and misinformation is unfortunate.

We make sure to advise women –

  • The COVID-19 pandemic is a rapidly evolving situation and each day scientists and researchers are learning more on how to prevent and mitigate the impact of the virus. New information comes out nearly each day and at times can contradict previous knowledge. So, it is important to remain updated on information.
  • However, it is crucial that you seek information from reliable and reputable sources, for e.g. WHO, UNICEF and the National Health Mission.
  • If you come across a piece of information in the media and especially social media such as YouTube that makes you curious or worries you, please verify that information from reliable and authentic sources. Do not act on a single source of information.
  • Do not be hasty in taking actions or decisions. Verify your doubts. Consult your doctor first.

To read more about our activities, please click here.

Maternal health services in India has its limitations

Maternal health services in India need to be wholistic

Maternity is joy. However, there are risks in pregnancy. Physical, mental and emotional setbacks take a toll on expectant mothers. And the journey of pregnancy until childbirth is often beset with barriers. A weak health system being at the foremost in low resource countries.

There have been improvements in the last two decades with better diagnosis and treatment facilities, but there is a long way to go.

Some maternal health in India related facts (source: NHM, GoI)

1 in 2 pregnant women have an antenatal check up in the first trimester.

Only 50% of women have four antenatal check ups during pregnancy.

Only 20% pregnant women have had full antenatal care as recommended by the department of health.

38.7% to 78.9%, a significant increase in institutional births in the last 10 years.

Medical attention for maternal health is necessary, even essential but its not enough or wholesome.

Studies show that 74% of mothers have experienced pregnancy specific anxiety (British Medical Journal) and 25% of pregnant women suffer from prenatal depression, mostly between 18-32 weeks of pregnancy (The Lancet). Women can be unaware of what to expect, and usually are not told about danger signs to look out for or precautions to take.

There are many mental health problems that a woman can experience in pregnancy. Mental health problems can happen at any time during the pregnancy. Also, mental health issues may appear for the first time in subsequent pregnancies.

Feeling sad all the time, remembering past experiences that were associated with distress, attacks of panic and fear, obsessive rumination and intense fear around birthing are complaints one often hears.

A woman's health and wellbeing affects her unborn baby too. In fact, most of the issues that newborns are affected by can be prevented by adopting often simple measures during pregnancy. Furthermore, there is significant disparity in maternal health care utilisation. Rural women and those who are challenged with literacy are disproportionately affected. In rural India, self care, awareness of changes in pregnancy and the need to attend to one's mental health and wellbeing during pregnancy remains an enigma. A study published in World Health and Population demonstrates how raising awareness and supporting women to take measures for their health and wellbeing during pregnancy, neonatal morbidity and mortality can be reduced.

"Pregnant women or mothers with mental health problems are less likely to care adequately for their personal needs, to seek and receive antenatal or postnatal care, or adhere to prescribed health regimens."

"If you want to reduce maternal mortality, you must focus on the mental health of mothers"- Sriram Haridass, India representative of the United Nations Population Fund.

The COVID-19 pandemic has caused difficulty and stressful time for many pregnant women and has taken a toll on women's health and wellbeing during pregnancy.

"The mental health issues and problems faced by women in rural India are even more serious. Owing to the lockdown and enforcement of social distancing norms, it was not possible for local health workers to reach every woman. In rural areas, most of the time, antenatal care services are provided in groups (usually 10 to 20 pregnant women at a facility). Many pregnant and lactating mothers are left without medical care." (S.Jungari)

It is important that you take care of yourself and use support services if you have any concerns about your health or your baby’s health (Learn how Kushal has responded to the COVID -19 epidemic). There is a lot of guidance and information resources to help you cope with the epidemic when pregnant. Take a look at the Maternal Mental Health Alliance site.  

We offer pregnancy mental health and wellbeing services in rural and urban India. Mental health and wellbeing workshops are carried out in remote communities. Our online pregnancy health and wellbeing guide is widely used by women in these communities to get wholistic information on how to stay physically and mentally healthy during pregnancy.

maternal health in India

Can I breastfeed – benefits outweigh potential risks

World Health Organisation (WHO) recommends that all mothers with confirmed or suspected COVID-19 continue to have skin-to-skin contact and to breastfeed. In all socioeconomic settings, breastfeeding improves survival and provides lifelong health and development advantages to newborns and infants.The novel Coronavirus has not been detected in the breastmilk of any mother with confirmed and suspected COVID-19 and there is no evidence so far that the virus is transmitted through breastfeeding. For more information please visit WHO.

Coronavirus: pregnant women urged to take extra caution by Indian Council of Medical Research (ICMR)

A comprehensive, well researched and objective article in The Hindu today outlines the advice given by ICMR to pregnant women.

The main points are –

Emerging evidence suggests that transmission of the novel coronavirus from mother to baby can take place antenataly or intrapartum. There is no evidence as yet of breast milk carrying the virus.

Pregnant women with heart disease are at greater risk of COVID-19 related complications.

Mental health issues in relation to the coronavirus is a concern. Increased anxiety and depression has been reported. Also, the incidence of domestic violence has risen.

For more information on our work in relation to COVID – 19 and pregnancy, please click here.

#coronavirus #pregnancy