NEW DELHI/LUCKNOW/MUMBAI/JAIPUR: When Sarika (name changed), 27, of Meerut in Uttar Pradesh felt labour pain late last month, her husband took her to a nursing home where she had been consulting a gynaecologist during her pregnancy.
The nursing home was shut and her doctor, over phone, advised her to arrange for a midwife-facilitated homebirth rather than going to the district hospital.
“I heeded to the doctor’s advice since the chances of contracting Covid-19 seemed higher at a government hospital teeming with people,” said Pawan Kumar (name changed), who teaches in a primary school. Sarika delivered a baby girl on April 29, helped by a retired auxillary nurse midwife. “I never wanted it this way but I am thankful I and my child are fine,” she said.
Sarika may have been lucky; many would not be. But for many months to come, we won’t even know of those who might have suffered in unimaginable ways, as they would either opt or be forced to deliver at home without medical supervision. A number of them will die, too, due to complications during the childbirth.
A look at the Health Management Information System, maintained by the Ministry of Health and Family Welfare suggests that in March 2020 — when the nationwide lockdown was enforced — institutional deliveries dropped by 43 per cent compared to March 2019. The number of childbirths registered in hospitals — public and private — across India stood at 17,17,500 in March last year while this year the number dropped to 9,71,782.
The differences are equally stark in case of Caeserian Section — which may be essential and life-saving in 5-15 per cent of all childbirths —which dropped by over 46 per cent in March, as compared to the same month last year.
The data for April is not yet available but the figures for March indicate at even more worrying trends that the coming weeks will throw. The numbers suggest the monthly institutional deliveries in March this year may have been the lowest in many years.
Data from states confirm the worrying dip in the numbers. In Lucknow, authorities said though the maternity hospitals were functioning throughout the lockdown, the number of expectant mothers coming for follow-up or even delivery, in public and private hospitals, dipped by around 20 per cent.
In Rajasthan, data suggest that every month, in about 2200 primary and community health centres and 1,100 private hospitals, nearly 1.5 lakh births were registered last year, but this figure has fallen by almost half during the period.
“The figures are alarming and while some of this could be explained by issues in reporting, the lockdown has a major role to play,” said Dr Subhasri B of CommonHealth.
“This massive disruption in maternal health services could push back India’s effort on ensuring safe deliveries by about 15 years.”
Sulakshna Nandi of Jan Swasthya Abhiyan said the drop is a direct result of women struggling to get access to health facilities due to lack of transport, panic among people and doctors and thousands in need being denied services by hospitals.
“There are numerous instances when women have delivered outside hospitals after being denied admission,” she said. “Many essential healthcare services have been hit during Covid-19 outbreak and pregnant women are among the worst hit.”
Last month, Delhi-based Sama group filed a PIL in the Delhi HC seeking directions to the government to pass appropriate orders to ensure that no pregnant woman is denied or discriminated against in accessing essential health services and to take action against hospitals that refuse access and/or admission to pregnant women. The court directed the government, too, but on ground, little has changed. Given that the Covid-19 threat is very real, was there a way out? “The government should have planned it better as there cannot be a compromise on essential healthcare services such as pregnant women needing medical care,” said Dr Subhashri.
“As it is, public health system has limited capacity in several states even during normal times, and now it is overwhelmed.”
Dr Nafis Faizi who teaches community medicine at the Aligarh Muslim University, had similar concerns. “When it comes to normal deliveries and C-Sections, we depend on private sector for majority of our needs. But today, with most of them either shut or denying services, it’s mostly medical college hospitals which are now overburdened,” he said.
What he says is reflected from many government run tertiary care centres. In Mumbai’s J J Hospital, for example, 600 women gave births this April as compared to 350 the same month last year.
“There are non-registered pregnant women also, who could not avail any other option and are turning up,” said Dr Ashok Anand in the hospital.