Factors affecting delayed and non-receipt of healthcare during the COVID-19 pandemic for women in rural Maharashtra, India: Evidence from a cross-sectional studyResearch in context
Summary: Background: Pathways to low healthcare utilisation under the COVID-19 pandemic are not well understood. This study aims to understand women's concerns about the health system's priorities and their increased burden of domestic responsibilities during COVID-19 as predictors of del...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-11-01
|
| Series: | EClinicalMedicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537022004709 |
| _version_ | 1811189662420566016 |
|---|---|
| author | Arnab K. Dey Nandita Bhan Namratha Rao Mohan Ghule Sangeeta Chatterji Anita Raj |
| author_facet | Arnab K. Dey Nandita Bhan Namratha Rao Mohan Ghule Sangeeta Chatterji Anita Raj |
| author_sort | Arnab K. Dey |
| collection | DOAJ |
| description | Summary: Background: Pathways to low healthcare utilisation under the COVID-19 pandemic are not well understood. This study aims to understand women's concerns about the health system's priorities and their increased burden of domestic responsibilities during COVID-19 as predictors of delayed or non-receipt of needed care for themselves or their children. Methods: We surveyed married women in rural Maharashtra, India (N = 1021) on their health and economic concerns between Feb 1 and March 26, 2021. This study period was when India emerged from the first wave of the pandemic, which had severely impacted the health systems, and before the second—even more devastating wave had started. We captured if women were concerned about access to non-COVID health services due to healthcare being directed solely to COVID-19) (exposure 1) and whether their domestic responsibilities increased during the pandemic (exposure 2). Our outcomes included women's reports on whether they delayed healthcare seeking (secondary outcome and mediator) and whether they received healthcare for themselves or their children when needed (primary outcome). We conducted adjusted regression models on our predictor variables with each outcome and assessed the mediation effects of delayed healthcare seeking for each of the exposure variables. Findings: We found that women who were concerned that healthcare was directed solely towards COVID-19 were more likely not to receive healthcare when needed (Adjusted Risk Ratio [ARR] = 1.49, 95% CI = 1.14, 1.95). We also found that women whose domestic care burden increased under the pandemic were more likely to delay healthcare seeking (ARR = 1.84, 95% CI = 1.05, 3.21). Delayed healthcare seeking mediated the associations between each of our exposure variables with our outcome variable, non-receipt of needed healthcare. Interpretation: Our findings suggested that women's perceptions of healthcare systems and their domestic labour burdens affected healthcare seeking during the pandemic in India, even before the second wave of COVID-19 incapacitated the health system. Support for women and health systems is needed to ensure healthcare uptake during crises. Funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, USA (grant numbers: R01HD084453- 01A1 and RO1HD61115); Department of Biotechnology, Government of India (grant #BT/IN/US/01/BD/2010); the EMERGE project (Bill and Melinda Gates Foundation Grants: OPP1163682 and INV018007; PI Anita Raj), and Bill and Melinda Gates Foundation Grant number INV-002967. |
| first_indexed | 2024-04-11T14:38:20Z |
| format | Article |
| id | doaj.art-46f725d802b94919a99a85de9afd93d7 |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-04-11T14:38:20Z |
| publishDate | 2022-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-46f725d802b94919a99a85de9afd93d72022-12-22T04:18:12ZengElsevierEClinicalMedicine2589-53702022-11-0153101741Factors affecting delayed and non-receipt of healthcare during the COVID-19 pandemic for women in rural Maharashtra, India: Evidence from a cross-sectional studyResearch in contextArnab K. Dey0Nandita Bhan1Namratha Rao2Mohan Ghule3Sangeeta Chatterji4Anita Raj5Center on Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA, USA; Corresponding author. Center on Gender Equity and Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093 California, USA.Center on Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA, USACenter on Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA, USACenter on Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA, USACenter on Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA, USA; School of Social and Political Science, University of Edinburgh, United KingdomCenter on Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA, USA; Division of Social Sciences, Department of Education Studies, University of California San Diego, La Jolla, CA, USASummary: Background: Pathways to low healthcare utilisation under the COVID-19 pandemic are not well understood. This study aims to understand women's concerns about the health system's priorities and their increased burden of domestic responsibilities during COVID-19 as predictors of delayed or non-receipt of needed care for themselves or their children. Methods: We surveyed married women in rural Maharashtra, India (N = 1021) on their health and economic concerns between Feb 1 and March 26, 2021. This study period was when India emerged from the first wave of the pandemic, which had severely impacted the health systems, and before the second—even more devastating wave had started. We captured if women were concerned about access to non-COVID health services due to healthcare being directed solely to COVID-19) (exposure 1) and whether their domestic responsibilities increased during the pandemic (exposure 2). Our outcomes included women's reports on whether they delayed healthcare seeking (secondary outcome and mediator) and whether they received healthcare for themselves or their children when needed (primary outcome). We conducted adjusted regression models on our predictor variables with each outcome and assessed the mediation effects of delayed healthcare seeking for each of the exposure variables. Findings: We found that women who were concerned that healthcare was directed solely towards COVID-19 were more likely not to receive healthcare when needed (Adjusted Risk Ratio [ARR] = 1.49, 95% CI = 1.14, 1.95). We also found that women whose domestic care burden increased under the pandemic were more likely to delay healthcare seeking (ARR = 1.84, 95% CI = 1.05, 3.21). Delayed healthcare seeking mediated the associations between each of our exposure variables with our outcome variable, non-receipt of needed healthcare. Interpretation: Our findings suggested that women's perceptions of healthcare systems and their domestic labour burdens affected healthcare seeking during the pandemic in India, even before the second wave of COVID-19 incapacitated the health system. Support for women and health systems is needed to ensure healthcare uptake during crises. Funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, USA (grant numbers: R01HD084453- 01A1 and RO1HD61115); Department of Biotechnology, Government of India (grant #BT/IN/US/01/BD/2010); the EMERGE project (Bill and Melinda Gates Foundation Grants: OPP1163682 and INV018007; PI Anita Raj), and Bill and Melinda Gates Foundation Grant number INV-002967.http://www.sciencedirect.com/science/article/pii/S2589537022004709COVID-19Maternal and Child HealthHealthcare utilisationDelay in seeking healthcareHealth system perceptionMediation |
| spellingShingle | Arnab K. Dey Nandita Bhan Namratha Rao Mohan Ghule Sangeeta Chatterji Anita Raj Factors affecting delayed and non-receipt of healthcare during the COVID-19 pandemic for women in rural Maharashtra, India: Evidence from a cross-sectional studyResearch in context EClinicalMedicine COVID-19 Maternal and Child Health Healthcare utilisation Delay in seeking healthcare Health system perception Mediation |
| title | Factors affecting delayed and non-receipt of healthcare during the COVID-19 pandemic for women in rural Maharashtra, India: Evidence from a cross-sectional studyResearch in context |
| title_full | Factors affecting delayed and non-receipt of healthcare during the COVID-19 pandemic for women in rural Maharashtra, India: Evidence from a cross-sectional studyResearch in context |
| title_fullStr | Factors affecting delayed and non-receipt of healthcare during the COVID-19 pandemic for women in rural Maharashtra, India: Evidence from a cross-sectional studyResearch in context |
| title_full_unstemmed | Factors affecting delayed and non-receipt of healthcare during the COVID-19 pandemic for women in rural Maharashtra, India: Evidence from a cross-sectional studyResearch in context |
| title_short | Factors affecting delayed and non-receipt of healthcare during the COVID-19 pandemic for women in rural Maharashtra, India: Evidence from a cross-sectional studyResearch in context |
| title_sort | factors affecting delayed and non receipt of healthcare during the covid 19 pandemic for women in rural maharashtra india evidence from a cross sectional studyresearch in context |
| topic | COVID-19 Maternal and Child Health Healthcare utilisation Delay in seeking healthcare Health system perception Mediation |
| url | http://www.sciencedirect.com/science/article/pii/S2589537022004709 |
| work_keys_str_mv | AT arnabkdey factorsaffectingdelayedandnonreceiptofhealthcareduringthecovid19pandemicforwomeninruralmaharashtraindiaevidencefromacrosssectionalstudyresearchincontext AT nanditabhan factorsaffectingdelayedandnonreceiptofhealthcareduringthecovid19pandemicforwomeninruralmaharashtraindiaevidencefromacrosssectionalstudyresearchincontext AT namratharao factorsaffectingdelayedandnonreceiptofhealthcareduringthecovid19pandemicforwomeninruralmaharashtraindiaevidencefromacrosssectionalstudyresearchincontext AT mohanghule factorsaffectingdelayedandnonreceiptofhealthcareduringthecovid19pandemicforwomeninruralmaharashtraindiaevidencefromacrosssectionalstudyresearchincontext AT sangeetachatterji factorsaffectingdelayedandnonreceiptofhealthcareduringthecovid19pandemicforwomeninruralmaharashtraindiaevidencefromacrosssectionalstudyresearchincontext AT anitaraj factorsaffectingdelayedandnonreceiptofhealthcareduringthecovid19pandemicforwomeninruralmaharashtraindiaevidencefromacrosssectionalstudyresearchincontext |