Discussion
The findings of this study reveal that in the study area, despite the pandemic, the proportion of pregnant women utilising various components of ANC increased from pre-pandemic (2019) to post-pandemic (2022) After the pandemic's breakout, pregnancy registration in the first trimester increased by 15 percent, micronutrient supplementation like IFA recorded an about 20 percent increase, and compliance with deworming tablets increased from 11 to 31 percent. Corroborating our findings, Nguyen et al. elaborated that although fewer health facilities provided ANC services amid the lockdown, most services for pregnant women continued to be offered, except for anthropometric measurements, which registered a decline [Our results show that in Bihar, a significantly lower proportion of pregnant women sought ANC in the first trimester compared to other states. Further, socio-economic disparities in utilization of ANC services still exists as shown in earler research [The present study established that sensitisation, counselling, and support extended to pregnant women by existing community health workers like ASHAs, ANMs, and AWWs increased after the onset of the pandemic. About 40–60 percent of the pregnant women reported that the health workers supported them in receiving ANC during the lockdown. Government guidelines to make essential services available at door step were issued [Various global health guidelines emphasise the importance of community participation in health delivery [Our findings confirm that the ground-level community and health systems were active during the pandemic. Policies and interventions should focus on effectively using ground-level health workers to create a source of health information and access to health services, thereby reducing the impact of health emergencies in the future. Increasing the community health workforce, especially in underserved resource-poor communities, can meet the urgent demand to educate and connect people to healthcare services during emergencies. In developing countries like India, participatory community programmes such as VHSND serve as promising platforms for delivering maternal health care with the help of ASHAs, ANMs, and AWWs.The major strength of this study is that it addresses the gap in the utilisation of ANC services before and after the pandemic based on women who were pregnant at the time of the midline and endline surveys, thus addressing the recall bias. However, it should be noted that the study was limited to selected areas. An earlier study pointed out that measuring community participation and social involvement factors will be essential to more adequately and accurately [