https://doi.org/10.1177/0020764020979019 International Journal of Social Psychiatry 1–3 © The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/0020764020979019 journals.sagepub.com/home/isp E CAMDEN SCHIZOPH Background The incidence and fear of COVID-19 continue to devastate the globe compromising the lives of over a million. As of 17th November 2020, India stands as the second-worst affected country with approximately 8.10 million recorded confirmed cases, and deaths totaling up to 131,435 (Government of India). India’s unprecedented lockdown measures and direct diversion of the country’s limited financial and workforce resources to manage COVID-19 have further aggravated India’s pre-existing fragile health system causing immense disruption of essential healthcare services. Evidence suggests that the country had witnessed significant difficulties and a sharp decline in accessibility and uptake of essential maternal healthcare services when it was under strictest lockdown (The Times of India, 2020). Although the Ministry of Health and Family Welfare, Government of India identified pregnant women as the ‘high risk group’ and ensured uninterrupted access to essential maternal health services by issuing guidelines in mid-April 2020, health facilities are currently facing immense challenges to maintain the demand (Ministry of Health and Family Welfare, 2020). More than 50% of institutional deliveries in India including urban and rural take place in public health facilities with rest occurring in private facilities and trustees (International Institute for Population Sciences Mumbai, 2016). With decades of efforts in place, India has indeed achieved progress in averting preventable maternal deaths by approximately 56% decrease in maternal mortality ratio (MMR) (254 in 2004 to 113 in 2018) with a significant rise in safe institu- tional and home deliveries in the presence of skilled birth attendants (Government of India, 2018; International Institute for Population Sciences Mumbai, 2016). Impact of COVID-19 on maternal health Public health experts are nonetheless agonized by the dire situation speculating occurrence of additional maternal and newborn deaths in coming months through unsafe and untimely deliveries and abortions. A recent report pub- lished in Lancet estimated an additional 56,700 and 115,700 maternal and child deaths respectively in low and middle-income countries (LMICs including India) under the scenario of 45% reduction in the supply of maternal health services stretched for six months (Roberton et al., 2020). Alongside, the United Nations Population Fund and partners forecasted around seven million unintended preg- nancies in India under interrupted access to essential fam- ily planning services (UNFPA, 2020). With pre-existing dearth and uneven distribution of trained healthcare providers and facilities, and recently overwhelming COVID-19 patients, the state, district, and in few cases block public facilities are immensely strug- gling to cater the current demand. Concerning reports from India suggest that due to facility closures, unanticipated denials from facilities, misbehavior and mistreatment (obstetric violence) by the healthcare providers, poor transport communication, and fear of infection (avoidance of visiting healthcare facilities), pregnant women are expe- riencing immense physical and mental hardships in access- ing safe maternity care (MahatabAlam, 2020; Shrivastava & Sivakami, 2020). Evidence from previously published studies indicate that these severe forms of negative and frightening experiences during pregnancy specifically dur- ing the periods of labor and delivery could directly affect the mental health of women leading to symptoms of depression, posttraumatic stress disorders, fear of child- birth and sometimes severe forms of birth-related phobia known as ‘tokophobia’ (Jha et al., 2018). Growing burden of fear of childbirth and associated factors Globally, the prevalence of fear of childbirth lies between 3.7% and 43% (O’Connell et al., 2017). The data on the prevalence of fear of childbirth in India with few available studies indicate it is 13% (facility level, Chhattisgarh, Fear of childbirth amid COVID-19 in India: Neglected aspect of maternal mental health Ria Saha 1 and Suresh Jungari 2 1 Independent Research Consultant, London, UK 2 Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India Corresponding author: Suresh Jungari, Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Ganeshkhind, Pune, Maharashtra 411007, India. Email: sureshjungariiips@gmail.com 979019ISP 0 0 10.1177/0020764020979019International Journal of Social PsychiatrySaha and Jungari letter 2020 Letter to the Editor