{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T20:15:50Z","timestamp":1769890550047,"version":"3.49.0"},"reference-count":55,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2023,5,29]],"date-time":"2023-05-29T00:00:00Z","timestamp":1685318400000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004421","name":"World Bank Group","doi-asserted-by":"publisher","award":["DOR STEM HEMS [6026-LK\/ 8743-LK]"],"award-info":[{"award-number":["DOR STEM HEMS [6026-LK\/ 8743-LK]"]}],"id":[{"id":"10.13039\/100004421","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,5,16]]},"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aims to describe how household economies and health service utilisation of pregnant and postpartum women were affected during the pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>This study was conducted in the Anuradhapura district, Sri Lanka.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>The study participants were 1460 pregnant and postpartum women recruited for the Rajarata Pregnancy Cohort during the initial stage of the COVID-19 pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Household economic (income, poverty, nutritional and health expenditures) and health service utilisation details during the COVID-19 pandemic were gathered through telephone interviews. Sociodemographic and economic data were obtained from the cohort baseline and analysed with descriptive and non-parametric analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of the 1460\u2009women in the sample, 55.3% (n=807) were pregnant and 44.7% (n=653) were postpartum women. Of the total sample, 1172 (80.3%) women participated in the economic component. The monthly household income (median (IQR)=212.39 (159.29\u2013265.49)) reduced (median (IQR)=159.29 (106.20\u2013212.39)) in 50.5% (n=592) families during the pandemic (Z=\u22128.555, p&lt;0.001). Only 10.3% (n=61) of affected families had received financial assistance from the government, which was only 46.4% of the affected income. The nutritional expenditure of pregnant women was reduced (Z=\u22122.023, p=0.043) by 6.7%. During the pandemic, 103 (8.8%) families with pregnant or postpartum women were pushed into poverty, and families who were pushed into poverty did not receive any financial assistance. The majority of women (n=1096, 83.3%) were satisfied with the free public health services provided by the public health midwife during the pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>During the early stages of the pandemic, healthcare utilisation of pregnant women was minimally affected. Even before the country\u2019s current economic crisis, the household economies of pregnant women in rural Sri Lanka were severely affected, pushing families into poverty due to the pandemic. The impact of COVID-19 and the aftermath on pregnant women will have many consequences if the policies and strategies are not revised to address this issue.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-070214","type":"journal-article","created":{"date-parts":[[2023,5,29]],"date-time":"2023-05-29T10:10:18Z","timestamp":1685355018000},"page":"e070214","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Impact of COVID-19 pandemic on health service utilisation and household economy of pregnant and postpartum women: a cross-sectional study from rural Sri Lanka"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0721-598X","authenticated-orcid":false,"given":"Sajan Praveena","family":"Gunarathna","sequence":"first","affiliation":[{"name":"Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nuwan Darshana","family":"Wickramasinghe","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thilini Chanchala","family":"Agampodi","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Indika Ruwan","family":"Prasanna","sequence":"additional","affiliation":[{"name":"Department of Economics, Faculty of Social Sciences and Humanities, Rajarata University of Sri Lanka, Mihintale, Anuradhapura, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suneth Buddhika","family":"Agampodi","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,5,29]]},"reference":[{"key":"2025120518485283000_13.5.e070214.1","doi-asserted-by":"crossref","first-page":"e901","DOI":"10.1016\/S2214-109X(20)30229-1","article-title":"Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a Modelling study","volume":"8","author":"Roberton","year":"2020","journal-title":"Lancet Glob Health"},{"key":"2025120518485283000_13.5.e070214.2","unstructured":"World Health Organization (WHO) . 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