In a shocking incident earlier this month, a pregnant woman died in an ambulance in Noida after being turned away from a number of private and government hospitals. This raises a chilling question for all of us: if this can happen somewhere so close to the nation’s capital, what is happening in the corners of the country? A second question that comes to mind is: when the lockdown was suddenly announced and then extended, what exactly was the plan for the millions of women who were/are due for childbirth?
Over the last 15 years, the state has been promising maternal well-being to pregnant women provided they turn up at public hospitals during labour, and has been providing a cash incentive to those that have institutional birth. Consequently, it has become almost routine for all pregnant women to reach health facilities during labour. Elaborate tracking systems have been instituted by the Ministry of Health and Family Welfare to track every pregnant woman, infant and child until they turn five.
Also read | Maternal death rate declining, says report
However, during lockdown, the state appeared to have forgotten those women expected to give birth. Even though recent epidemics have identified pregnant women as people being ‘high risk’, no reference was made this time on the need to provide emergency services for pregnant women. Frontline workers were pressed into community surveillance, monitoring and awareness building for COVID 19. The public health system was overburdened with handling the pandemic: most secondary and tertiary hospitals were either those designated as COVID-19 facilities or those unequipped with enough PPE kits.
Adverse fallout on pregnant women
The recent news has been providing many glimpses of the stigma and paranoia regarding the virus and its fallout upon pregnant women and infants. There was the 20-year-old in Telangana with anaemia and high blood pressure, who died after being turned away by six hospitals. Similarly, a 25-year-old woman in labour coming from a COVID-19 containment area in Delhi was turned away by at least six hospitals and clinics. She finally gave birth outside the All India Institute of Medical Sciences. Innumerable other incidents have possibly gone unreported. These indicate that in these 12 weeks, the approximately 9,00,000 pregnant women (15% of the six million women giving birth) who needed critical care had to face enormous hurdles to actually obtain treatment at an appropriate hospital. Added to this were the women who have had miscarriages or sought abortions: that would be another 45,000 women every single day.
The government rather belatedly issued a set of guidelines a month after lockdown started, but that only compounded the confusion. Pregnant women had to be ‘recently’ tested and certified COVID-19-negative to enter a ‘general hospital’ but it was not clear how this can happen once they are in labour, as the test results need a day’s turnaround at the very least. The fundamental question here is: when the state compels people to modify their behaviour through an inducement like a cash incentive, doesn’t that put the onus on the state for ensuring effective systems for maternal care?
Also read | 68% of under-5 deaths in India due to child, maternal malnutrition
Need to scrutinise private sector
The health policymakers need to acknowledge the shortcoming of an overstretched and under-resourced system in responding to the critical care needs of pregnant women during crises. Although 80% doctors and 64% beds are in the private sector, clinics have closed down and private hospitals have stepped back fearing infections, while larger hospitals have begun charging exorbitant amounts. The role of the private sector therefore needs to be scrutinised.
India’s Maternal Mortality Ratio came down to 122 deaths per 1,00,000 live births (SRS 2017), from 167 per 1,00,000 births in 2011-13. Much effort and investment over many years have led to this decrease. As India struggles to manage the COVID-19 pandemic, the hard-won gains of the last 15 years can be erased with one stroke.
The pandemic has amplified many inequalities and shows up sharply the state’s abdication of responsibility for prevention of lives lost, putting the entire responsibility of health protection on the individual citizen. In order to win back the trust of pregnant women, the state will have to account publicly for how the millions of deliveries took place; or how abortions, miscarriages and childbirth complications were handled. Improved maternal health was the lynchpin around which public health systems had been strengthened over the last 15 years. As the country slowly emerges from a total lockdown into a longer-term management strategy, it is time to consider doing things differently for improving maternal well-being.
Jashodhara Dasgupta writes on gender, rights and health
