Introduction
The study aimed to evaluate COVID-19 associated psychological distress among pregnant and postpartum women during the second wave of COVID-19 in India.
Methods
A cross-sectional survey was done using a pre-validated tool involving 491 participants attending a tertiary-care hospital during the second wave of COVID-19 in India.
Results
Three-fourths of participants experienced negative emotions such as fear and various features of depression. Participants (75%) reported COVID-related news on TV/Radio/Newspapers including social media as the major trigger for these negative emotions. Loss of social support mainly affected postpartum women (p < 0.001) and working women (p < 0.001). Inability to access healthcare services had negative associations with age (p < 0.001), education (p < 0.001), and socioeconomic class (p < 0.001). Various coping strategies being followed by participants included watching TV/Videos or reading books (93%), resorting to social media (77%), spending more time praying and meditating (86%), and engaging in hobbies (56%).
Conclusion
During the second wave, the COVID-19 pandemic had a significantly high negative impact on the psychological and social well-being of pregnant and postpartum women. Hence, it is important to initiate appropriate preventive and corrective steps by the policymakers for any future waves of the pandemic.
Keywords : Developing country · COVID-19 · Pregnant women · Postpartum women
The world is looming with various waves of the COVID-19 pandemic, and India has recently experienced an intense second wave [1]. Wherein, the various vulnerable groups have been neglected and unduly affected. Among these groups, pregnant and postpartum women have felt various adversities [2, 3]. Though the vaccination drive has been ramped up throughout the country yet the possibility of a third wave is tangible. Due to prevalent vaccine hesitancy among pregnant and postpartum women, the pandemic has increased their susceptibility to adverse mental health outcomes. Pandemic-induced fear, restrictions, and confusion over the acceptance of the COVID-19 vaccine may also lead to impaired psychosocial functioning and negatively influence maternal, neonatal, and infant outcomes [4, 5].
Few studies have been conducted to assess the adverse effects of COVID-19 on pregnant and postpartum women.
The studies have mostly used validated tools such as the Generalized Anxiety Disorder 7‐item Scale (GAD‐7), State-Trait Anxiety Inventory, Beck Depression Inventory- II, Edinburgh Depression Scale (EDS), and Impact of Event Scale-Revised (IES-R) [5–7]. However, results from these studies cannot be generalized due to the unique socio-cultural make-up of India. Moreover, the scales used may not be uniformly applied to pregnant and postpartum women due to the particularity of the life stage [8]. Thus, it is imperative to assess the quantum of COVID- 19-associated psychosocial changes among pregnant and postpartum women using a specific validated tool [4]. Therefore, this study aims to assess the negative emotions experienced by pregnant and postpartum women during the second wave the of COVID-19 pandemic in India. Apart from this, the study also looks into the various emotional triggers, and pregnancy concerns and coping strategies adopted by these women due to the pandemic in the Indian scenario.
This study cohesively assesses various social, emotional, and psychological effects of the COVID-19 pandemic such as fear and negative emotions. Along with it, it has also assessed factors responsible for negative emotions, pregnancy concerns, and the coping strategies adopted by pregnant and postpartum women in the second wave of the pandemic.
The survey participants had considerable fear of themselves and their family members contracting COVID-19 infection. Depressive symptoms like loneliness, helplessness, hopelessness, and worthlessness affected the majority of women similar to studies conducted in Spain [12] and Iran [13] stating that pregnant women during the COVID pandemic had greater levels of phobic anxiety and depression. This highlights the importance of social support required by this population. The participants also experienced anxiety, phobias, and depressive symptoms similar to the first wave in India (Table 6). [14–16]
Various triggers have been identified that might be responsible for the fear/negative emotions during this pandemic. Women, especially those with higher socioeconomic status and higher education levels, were negatively affected by COVID-related news on TV/Radio/Newspapers including social media. This might be due to the greater access of these women to TV and other means of social media as compared to women who were less educated and belonged to low socioeconomic status. Similar results were reported in a study conducted in Iran [13], where women residing in urban areas showed higher anxiety levels. This highlights the need to provide reliable information to these women. Telemedicine can be used by healthcare providers to provide satisfying answers to these women related to their concerns about the possible effects of COVID-19 disease on mother and unborn/newborn baby, to increase their awareness about COVID-19 signs and symptoms, and to advise them to perform yoga and deep breathing along with the intake of a healthy diet to maintain overall well-being.
Another emotional trigger observed in the present study was the inability to access healthcare services due to the pandemic similar to a study conducted in the UK [17]. Inadequate prenatal services such as reduced frequency of physical appointments with the treating doctor and delay in ultrasounds raised anxiety levels among pregnant women. Moreover, avoiding visits to hospitals due to the fear of contracting COVID-19 infection raised concerns among these women about whether their pregnancy was going right or not. Similarly, postpartum women have concerns about selfcare and newborn care due to the reduced healthcare visits aggravated by the loss of social support. Hence, it is imperative to improve virtual maternity (antenatal and postnatal) care services, especially in a low-resource country like India where the majority of the population has no access to any virtual means.
Government norms for social restrictions to combat the COVID-19 pandemic have led to social isolation among these women. There is either reduced support or a total lack of support from friends and family. This lack of social support is yet another emotional trigger among pregnant and postpartum women. Similar findings have been reported in the study conducted in the UK [18] where women reported their anxiety and concerns due to the lack of support. This has become of utmost importance to make these women aware of various stress coping mechanisms.
The present study also shows the various coping strategies opted by these women to overcome the negative feelings associated with the pandemic. Stress coping strategies mainly included watching TV shows or reading books, resorting to social media, spending time in prayers and meditation, engaging in hobbies, and spending time with family. A study conducted in the USA [19] supports our findings stating that pregnant and postpartum women coped with COVID-19-related stress by engaging in healthy behavior related to diet and activity, making time to relax, and spending time with family and friends either offline or online mode.
Our study holds certain implications. COVID-19 pandemic- associated fear and stress have aggravated the psychosocial functioning of pregnant and postpartum women. It has become imperative for healthcare providers to convincingly respond to all queries of these women related to the effects of this pandemic on their health as well as the health of the unborn/newborn. It is also crucial to motivate these women to adopt stress coping strategies such as doing yoga, meditation, engaging in hobbies, and spending quality time with family. Moreover, authorities must take appropriate steps to strengthen virtual maternal care services in a country like India where the majority of the population has no access to any virtual means.
This study is one of the initial attempts to assess the effects of the COVID-19 pandemic on the psychological and social functioning of pregnant and postpartum women in India. The present study used a questionnaire that was validated to study pertinent components of psychological stress like negative emotions, triggers, and coping mechanisms for pregnant and postpartum women. This study highlights the need to strengthen virtual maternity services in pandemic conditions. Moreover, the study has been conducted during the second wave of the COVID-19 pandemic in India where this population group has been affected worse aggravating the negative emotions experienced them. This study has the limitation of using purposive sampling with the snowball technique which limits its ability to fully represent the entire population. Multicentric studies using stratified sampling techniques should be carried out to get a complete picture of the condition of pregnant and postpartum women during this pandemic.
Conflict of interest We, the authors approve that the requirement for the authorship as stated have been met and we believe that the manuscript represents honest work.
