Immediate impact of stay-at-home orders to control COVID-19 transmission on socioeconomic conditions, food insecurity, mental health, and intimate partner violence in Bangladeshi women and their families: an interrupted time series

Abstract

Background: Stay-at-home orders (lockdowns) have been deployed globally to control COVID-19 transmission, and might impair economic conditions and mental health, and exacerbate risk of food insecurity and intimate partner violence. The effect of lockdowns in low-income and middle-income countries must be understood to ensure safe deployment of these interventions in less affluent settings. We aimed to determine the immediate impact of COVID-19 lockdown orders on women and their families in rural Bangladesh.

Methods: An interrupted time series was used to compare data collected from families in Rupganj upazila, rural Bangladesh (randomly selected from participants in a randomised controlled trial), on income, food security, and mental health a median of 1 year and 2 years before the COVID-19 pandemic to data collected during the lockdown. We also assessed women's experiences of intimate partner violence during the pandemic.

Results: Between May 19 and June 18, 2020, we randomly selected and invited the mothers of 3016 children to participate in the study, 2424 of whom provided consent. 2414 (99·9%, 95% CI 99·6-99·9) of 2417 mothers were aware of, and adhering to, the stay-at-home advice. 2321 (96·0%, 95·2-96·7) of 2417 mothers reported a reduction in paid work for the family. Median monthly family income fell from US$212 at baseline to $59 during lockdown, and the proportion of families earning less than $1·90 per day rose from five (0·2%, 0·0-0·5) of 2422 to 992 (47·3%, 45·2-49·5) of 2096 (p<0·0001 comparing baseline with lockdown period). Before the pandemic, 136 (5·6%, 4·7-6·6) of 2420 and 65 (2·7%, 2·1-3·4) of 2420 families experienced moderate and severe food insecurity, respectively. This increased to 881 (36·5%, 34·5-38·4) of 2417 and 371 (15·3%, 13·9-16·8) of 2417 during the lockdown; the number of families experiencing any level of food insecurity increased by 51·7% (48·1-55·4; p<0·0001). Mothers' depression and anxiety symptoms increased during the lockdown. Among women experiencing emotional or moderate physical violence, over half reported it had increased since the lockdown.

Interpretation: COVID-19 lockdowns present significant economic, psychosocial, and physical risks to the wellbeing of women and their families across economic strata in rural Bangladesh. Beyond supporting only the most socioeconomically deprived, support is needed for all affected families.

Funding: National Health and Medical Research Council, Australia.

Figure 1

Food security at BRISC trial baseline and endline, and during COVID-19 lockdown in families in Rupganj upazila, Bangladesh Each square represents 1% of the survey sample. BRISC=Benefits and risks of iron interventions in children trial.

Figure 2

CES-D scores at BRISC trial baseline and endline, and during COVID-19 lockdown Violin plot showing median (IQR), together with kernel density plot to show frequency of data. CES-D=Centre for Epidemiologic Studies-Depression Scale. BRISC=Benefits and risks of iron interventions in children trial.

Figure 3

Intimate partner violence during COVID-19 lockdown Prevalence of intimate partner violence during COVID-19 lockdown, and reported change (more frequent, no change, or less frequent) from before the pandemic. Participants could report multiple forms of violence. Data are presented as prevalence of emotional violence (being insulted [E1], humiliated [E2], intimidated [E3], or threatened [E4]), physical violence (being slapped or having something thrown [P1]; being pushed or having their hair pulled [P2]; hit with a fist [P3]; kicked, dragged, beaten, choked, or burned [P4]; or threatened with or having a weapon used [P5]), or sexual violence (physically forced to have sexual intercourse [S1]).