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Opinion: How Renewed Lockdowns Might Affect Women’s Health Services In Rural India And Further Tire Already Weak Systems

The unmet need for family planning services is already high and disruptions to health services will have far-reaching consequences for the health of women, write Poonam Muttreja and Mandira Kalra Kalaan of Population Foundation of India

Opinion: How Renewed Lockdowns Might Affect Women's Health Services In Rural India And Further Tire Already Weak Systems

With over 312,000 cases registered on April 21st India’s daily caseload is now the highest of any country since the pandemic began over a year ago. With an overall caseload over 15 million, the second highest after the United States, the country’s fragile health infrastructure is being pushed to a breaking point. Reports from state after state suggest that patients and their families are scrambling to secure hospital beds and governments are struggling to provide oxygen and critical life-saving medicines for serious patients.

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Several health facilities, including AIIMS in Delhi, which have been treating large numbers of non-COVID patients through the pandemic have suspended routine OPD services. Doctors, nurses and other healthcare professionals are being diverted to COVID-only duty as states convert non-COVID hospitals into COVID treatment centres. As we had witnessed during the lockdown last year, it is likely that health care services will be affected due to local restrictions already in place in a number of states and union territories, and health facilities either shut down or converted for delivering pandemic related services. Furthermore, restrictions on mobility and fear of health centres also reduce access to health care services, including family planning and reproductive health services. With ASHAs, ANMs and Anganwadi Workers diverted to COVID care and limited outreach services such as Village Health, Sanitation and Nutrition Days (VHSND), the effect in rural areas is magnified.

Population Foundation of India’s own analysis of the first lockdown shows that there have been severe drops in access to contraception, ante-natal care services and institutional deliveries. In Bihar, Rajasthan and Uttar Pradesh, adolescents reported an unmet need for reproductive health services, especially menstrual hygiene products. While it is commendable that the Ministry of Health and Family Welfare (MOHFW) included reproductive health services in the list of essential services, women’s access to high quality uninterrupted services have been impacted.

A recent UNICEF report, Direct and Indirect Effects of COVID-19 Pandemic and Response in South Asia, estimates that disruptions due to the pandemic will result in significantly higher numbers of maternal and child deaths, unwanted pregnancies and disease related mortality in women and adolescents than in previous years. India alone is likely to record an additional 154,000 child deaths. Maternal deaths are estimated to rise by 18% and stillbirths by 10%. Of the 3.5 million additional unintended pregnancies estimated due to disruptions in access to reproductive healthcare, 3 million are likely to be in India.

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The unmet need for family planning services is already high and disruptions to health services will have far-reaching consequences for the health of women. Research suggests that as a result of the pandemic, 26 million couples in India will have no access to contraceptives. The inability to access contraceptives is likely to result in an additional 2.4 million unintended pregnancies and close to 2 million Indian women will be unable to access abortion services due to COVID 19.

Emergency situations, such as this pandemic, require even the strongest health systems to reorganise and prioritize the needs of vulnerable populations. India’s fragile healthcare sector is not equipped for the unprecedented rise in COVID-19 cases in this second wave. With only 5 hospital beds per 10,000 population and 8.6 physicians for every 10,000 people the country does not have the infrastructure for a crisis of this enormity. Moreover, inefficiency and acute shortages have not kept pace with the growing needs of the population. Under these prevailing circumstances there will also be severe implications for not only routine health services but also the COVID-19 vaccine roll-out. Challenges remain for the states as existing nursing personnel are expected to undertake both COVID-19 vaccination as well as provide routine health care services, including reproductive health services and immunisation. The differential pricing that has been proposed as the vaccine is opened to people below 45 will further underscore health inequity and inadequate supplies. It is likely that those who are most vulnerable or living in remote areas that are distant from health facilities will not have access to vaccination.

The disruption to essential health services due to the high burden of COVID-19 cases demonstrates the need to build health systems that have the capacity to not only cater to the ever-increasing demand for health services but also withstand crises such as this one. Shifting government priority to focus on health management and disease prevention is critical. So is ensuring greater equity in accessing healthcare – improving public health infrastructure is vital to ensuring quality health care for all.

Also Read: Second Wave Of Coronavirus: Countries Promise Medical Support To India Amid Rising COVID-19 Cases

Frontline health workers have been the face of India’s fight against COVID over the last 12 months. Greater investments in their capacity building during and beyond the pandemic is necessary, given that they represent the first and often only point of contract with the public health system for rural women.

The COVID-19 pandemic poses one of the biggest health and humanitarian crises India and the world has ever witnessed. It has exacerbated existing challenges to public health, particularly for the most vulnerable and marginalised. As the government fire-fights to realign and redirect resources to where they are needed most, we must recognise that this pandemic has underscored the importance of investing in public health and prioritizing universal health coverage to ensure uninterrupted essential health services for India’s most vulnerable.

(The article was co-authored by Poonam Muttreja, Executive Director of the Population Foundation of India and Mandira Kalra Kalaan, Associate Director, Communication, Population Foundation of India.)

Disclaimer: The opinions expressed within this article are the personal opinions of the author. The facts and opinions appearing in the article do not reflect the views of NDTV and NDTV does not assume any responsibility or liability for the same.

NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (WaterSanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollutionwaste managementplastic banmanual scavenging and sanitation workers and menstrual hygiene

World

24,06,78,961Cases
20,23,40,977Active
3,34,39,331Recovered
48,98,653Deaths
Coronavirus has spread to 195 countries. The total confirmed cases worldwide are 24,06,78,961 and 48,98,653 have died; 20,23,40,977 are active cases and 3,34,39,331 have recovered as on October 18, 2021 at 4:17 am.

India

3,40,81,315 13,596Cases
1,89,6946,152Active
3,34,39,331 19,582Recovered
4,52,290 166Deaths
In India, there are 3,40,81,315 confirmed cases including 4,52,290 deaths. The number of active cases is 1,89,694 and 3,34,39,331 have recovered as on October 18, 2021 at 2:30 am.

State Details

State Cases Active Recovered Deaths
Maharashtra

65,91,697 1,715

32,230 994

64,19,678 2,680

1,39,789 29

Kerala

48,54,321 7,555

88,186 3,292

47,39,270 10,773

26,865 74

Karnataka

29,83,459 326

9,479 58

29,36,039 380

37,941 4

Tamil Nadu

26,87,092 1,218

14,814 208

26,36,379 1,411

35,899 15

Andhra Pradesh

20,60,472 432

6,034 159

20,40,131 586

14,307 5

Uttar Pradesh

17,10,028 9

119 10

16,87,011 19

22,898

West Bengal

15,80,530 624

7,421 24

15,54,132 634

18,977 14

Delhi

14,39,390 32

320 6

14,13,981 38

25,089

Odisha

10,35,077 443

4,542 68

10,22,250 508

8,285 3

Chhattisgarh

10,05,654 16

183 2

9,91,901 14

13,570

Rajasthan

9,54,390 2

42 2

9,45,394 4

8,954

Gujarat

8,26,290 10

207 6

8,15,997 16

10,086

Madhya Pradesh

7,92,684 5

84 12

7,82,077 17

10,523

Haryana

7,71,076 15

123 9

7,60,904 6

10,049

Bihar

7,26,026 5

48 4

7,16,317 1

9,661

Telangana

6,68,955 122

3,924 55

6,61,093 176

3,938 1

Assam

6,06,468 205

3,436 46

5,97,082 245

5,950 6

Punjab

6,02,035 27

227 8

5,85,264 16

16,544 3

Jharkhand

3,48,430 7

122 1

3,43,173 8

5,135

Uttarakhand

3,43,756 9

178 1

3,36,181 8

7,397

Jammu And Kashmir

3,31,062 95

843 12

3,25,793 107

4,426

Himachal Pradesh

2,21,437 131

1,303 5

2,16,414 125

3,720 1

Goa

1,77,522 60

604 6

1,73,572 62

3,346 4

Puducherry

1,27,396 52

585 13

1,24,961 64

1,850 1

Manipur

1,22,737 104

1,422 0

1,19,418 102

1,897 2

Mizoram

1,12,848 249

11,633 1,143

1,00,829 1,389

386 3

Tripura

84,321 16

104 4

83,401 12

816

Meghalaya

82,953 55

845 32

80,673 86

1,435 1

Chandigarh

65,302 3

25 3

64,457 6

820

Arunachal Pradesh

54,987 7

140 30

54,567 37

280

Sikkim

31,749 4

174 8

31,184 12

391

Nagaland

31,611 40

248 12

30,689 28

674

Ladakh

20,878 2

36 10

20,634 12

208

Dadra And Nagar Haveli

10,676 1

4 1

10,668

4

Lakshadweep

10,365

0 0

10,314

51

Andaman And Nicobar Islands

7,641

9 0

7,503

129

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