Data | Apathy of family and high costs hinder maternal healthcare Premium

In 28% of the cases, either the husband or the family deemed antenatal care visits unnecessary for the pregnant woman

Maternal healthcare: A pregnant woman waits for consultation with a doctor at a civil hospital in Dehra, Himachal Pradesh, on April 24, 2023. | Photo Credit: AFP

In May, a United Nations report showed that India was among the 10 countries that together accounted for 60% of global maternal deaths, stillbirths and newborn deaths. India accounted for over 17% of such deaths in 2020, followed by Nigeria (12%) and Pakistan (10%). The report also showed that India had the second-highest number of maternal deaths (24,000) after Nigeria.

The report reiterated the three major interventions that help reduce maternal deaths: going for four antenatal care visits or ANC visits (during pregnancy), having a skilled attendant at birth, and receiving postnatal care (after childbirth) within the first two days after birth (PNC). During antenatal care, health workers educate women about complications during pregnancy and labour, and after childbirth. The visits also help women get access to micronutrient supplementation (iron and folic acid supplements) to prevent anaemia, which can lead to maternal and perinatal mortality. It also helps them seek treatment for hypertension to prevent eclampsia, and to get immunisation against tetanus and other endemic diseases.

Table 1 | The table shows the frequency of antenatal care (ANC) visits in India and the socio-economic background of pregnant women who completed all four ANC visits

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Table 1 shows that in India, 6.1% of mothers did not go for even one ANC visit during their recent pregnancy, while 34.1% of them went once, twice or thrice, which is less than the four visits recommended by the WHO. There was also a noticeable urban-rural divide. More importantly, only 39.9% of mothers who had no school education completed four ANC visits compared to 68.6% of those who completed 12 years of schooling. Such stark differences were observed across class and caste. A much higher share of mothers from wealthier households and a relatively high share of upper castes completed four ANC visits.

Postnatal care within the first two days after birth is recommended because mothers are in their most vulnerable state in the postpartum period (42 days after childbirth). According to the WHO, “most maternal and infant deaths occur in the first month after birth, with almost half of the postnatal maternal deaths occurring within the first 24 hours, and 66% occuring during the first week.”

Table 2 | The table shows the socio-economic background of women who visited hospitals for postnatal care (PNC) after two days of childbirth or never did so (figures in %)

*includes those who did not know the number of days

As shown in Table 2, 16% of women in India did not have even one postnatal health check-up, while 22.8% of them had a delayed check-up two days after childbirth. There were stark differences among mothers along with education levels and wealth status of the households. In the poorest 20% of the households, 26.3% of women never had a postnatal health check-up, whereas among the richest, only 7.9% did not.

More worryingly, only 50-60% of husbands were informed by a health worker at any time during the pregnancy of the specific signs of pregnancy-related complications. And only about 64% of them knew what to do if the woman had a complication (Table 3).

Table 3 | The table lists the share of men/fathers who were informed about complications in pregnancy by health providers/workers

Table 4 shows that very few women refuse antenatal care on their own (only 3.9% of women did so). In most cases, it was the apathy of the husband or her family that led to fewer ANC visits. In 28% of the cases, it was either the husband or the family who deemed ANC visits unnecessary or did not allow the woman to visit the centre. Money is also an important factor with 27.7% citing lack of finance for refusing such visits.

Table 4 | The table lists the reasons given behind the lack of antenatal care visits (figures in %)

It is also important to point out that 8% of Indian women did not receive tetanus shots which help prevent infections during and after surgery. Also, in about 11% of cases, no skilled health providers, who could detect and manage complications, were present at the time of delivery.

rebecca.varghese@thehindu.co.in, vignesh.r@thehindu.co.in

Source: National Family Health Survey-5 (2019-21), UN report