Maternity, child health services crumble during COVID-19 pandemic

On the evening of March 30, a video clip on Twitter showed a young pregnant woman die inside an autorickshaw as she was being taken to the hospital in Mumbai's suburban region of Mumbra. A heart-wrenching clip in which the relative holding the woman in his arms mentioned that she was denied admission in at least four different hospitals they approached before finally giving in.

This is not an isolated case. In New Delhi, Milita Shinde who was in the ninth month of her pregnancy in the first week of May, was bleeding and needed immediate hospitalisation. It was well past 10pm when she reached Kasturba hospital, where she was to deliver, only to be told that the facility had been designated as a COVID-19 hospital hours before and was shut for fumigation. She was then referred to Jag Parvesh Chandra hospital which is miles away in Delhi's suburban Shahadra. The latter again, refused to admit her on the pretext that it was not a tertiary care centre and could not tackle complicated cases especially in times of a prevailing pandemic. By this time already a few hours had passed.

Shinde's was a high-risk case where an ultrasound was essential to know if she had to undergo emergency delivery. At the same time, her blood pressure had to be kept under normal levels lest it could be fatal, for both the mother and the baby. She was then taken to Lady Hardinge hospital who refused to admit her saying that all beds were occupied. After a lot of convincing and some political connections, she was finally taken in and was administered emergency caesarean. "Had she been late by another few hours, the baby could have died due to blood loss, says Dr Wamique Uzra, from Delhi's Safdarjung hospital who is also a member of the Medical Support Group.

"There have been several instances where the security guards outside hospitals themselves stop these women from even coming in for regular antenatal check-ups, unless it's an emergency. So, no more regular check-ups for expecting mothers, which is very essential for determining the health of both, the mother and the foetus," says Uzra.

In the wake of the COVID-19 pandemic and the ensuing nationwide lockdown, with no clear policies or guidelines to be followed in the case of expecting mothers coming in for antenatal check-ups or even young mothers looking at accessing emergency abortion services, maternal health services across the country have been totally disrupted, leaving thousands of women in the lurch. The hospitals and health care centres often come across as apathetic, insensitive and ignorant, leaving women in extremely vulnerable conditions to fend for themselves. At the policy level, there are no clear guidelines to be followed in case of COVID-positive mothers. "So, irrespective of the urgency of the situation, the authorities at hospitals demand a Covid test report before admitting an expecting mother but there are no clear guidelines as to how long is a test valid for? So, if the patient has got herself tested for COVID a fortnight before getting admitted, does it hold good?" asks a gynaecologist from a leading private hospital in Mumbai who did not wish to be named.

Childbirth is a natural process and cannot wait for the lockdown to get over, plead experts working in the area of maternal health and reproductive rights. In Madhya Pradesh, within a short span of two months 12 cases of post maternal deaths got reported across five districts in the state due to negligence which could have been avoided, says Sandhya Gautam, who works with the National Alliance for maternal health and human rights (NAMHHR) across the states of Jharkhand, MP, UP and Karnataka. "The lockdown was announced without any consideration for maternal health services. Asha workers and auxiliary nurse midwives who form an essential backbone for expecting mothers in villages and communities, got busy with other non-essential services," she said.

In April, the ministry sent guidelines that maternal services should be considered essential services, yet till date there has been a severe shortage of folic acid and iron tablets which are extremely necessary for the development of the foetus, there's almost an absence of contraceptive services, essential sonographies and ultrasounds are not being carried out in a number of healthcare facilities. By sharing the experience of someone in one of the primary healthcare centres in the state of MP, Gautam highlights the startling plight of those trying to access safe methods of birth control. "When this person tried using the condom dispenser, she was surprised to see that it was empty. Upon questioning the doctor on duty about it, the latter commented that it was done keeping in mind the rule of social distancing."

On April 14, the central government first formulated the guidelines on enabling the delivery of Reproductive, maternal, newborn, child, adolescent health and nutrition (RMNCAH+N) services which are amongst the most crucial interventions to address maternal and child morbidities and mortalities. The guidelines were established with a view to ensure that in times when the COVID-19 pandemic has demanded additional attention of the entire public healthcare system, maternal and child health do not get negatively affected.

On May 27, the Health secretary again urged states across the country to follow the guidelines. Yet, in the district of Rewa in Madhya Pradesh, a 25-year-old woman who had been bleeding profusely for a week, was shunned from the district hospital. "In November 2019, the woman had an intra-uterine device inserted in order to prevent pregnancy. Since the past one month she was bleeding and was suffering from severe pain in the abdomen. When she went to the doctor a fortnight back, they refused to treat her saying that she can come after COVID is over. There was no physical examination to check if the device had moved from the location in the abdomen which was causing bleeding and the pain. The hospital simply refused to help," says Meenakshi Singh, who works with the MHRC in Madhya Pradesh.

Even in metro cities such as Mumbai and Delhi, new mothers and to-be mothers are finding it difficult to even an approach the hospital in cases of emergency, because basic infrastructure is not in place. Ambulances take hours to arrive and sometimes when they do, after hours, it is already too late."Women are taking the help of auxiliary nurse midwives to get their babies delivered at home, sometime under medical supervision but most times, without the supervision of any medical practitioner because there are none available," says a practising gynaecologist at a private hospital in Mumbai.

About a week back, Uzma, a social worker based in New Delhi, helped two women in their last month of pregnancy deliver healthy babies at home. The women who came to her for help with the delivery, refused to visit a hospital saying that if they did, they'd be isolated and quarantined on the pretext of having contracted the coronavirus because "that's what they do to Muslims who go to the hospitals."

These women, mostly living in the areas of Mustafanagar in Delhi are in fear of being killed. "The scars left behind by the riots about five months back have still not healed. They said they'd rather have a Dai who'd be able to deliver the baby at home, than visit a hospital," says Uzra.