Opinion: Safeguarding The Health Of Mothers During The COVID-19 Pandemic

Opinion: Safeguarding The Health Of Mothers During The COVID-19 Pandemic

Blogs, Coronavirus Outbreak, Uncategorized
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Opinion: Safeguarding The Health Of Mothers During The COVID-19 Pandemic

Over the past two decades, India has achieved impressive gains in reducing maternal deaths. India’s maternal mortality rate (maternal deaths/100,000 live births) has decreased from 407 in 2000 to 113 in 2016-18, according to the Sample Registration System (SRS) Bulletin 2020. With this progressive decline, India was on track to achieving the United Nations Sustainable Development Goals (SDG) of 70 births/100,000 live births by 2030. These gains were achieved through increases in institutional deliveries and a focus on quality and coverage of services under National Health Mission (NHM), through various schemes such as Janani Shishu Suraksha Karyakram, Janani Suraksha Yojana, and newer initiatives like LaQshya and Pradhan Mantri Surakshit Matritva Abhiyan.

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In the wake of the COVID-19 pandemic, the reduced capacity of healthcare services for women and children could reverse progress achieved over the years in reducing maternal mortality. A systematic review of the available global data on the effects of the COVID-19 pandemic published in The Lancet, on maternal and perinatal outcomes, found increased maternal mortality and stillbirth, maternal stress, and ruptured ectopic pregnancies during the pandemic compared with before the pandemic. In Low and Middle-Income Country (LMIC) settings particularly, stillbirths may have seen significant increases.

A study in Uttar Pradesh observed an overall decrease of 2.26 per cent in the number of institutional deliveries. Antenatal care services were the worst affected with 22.91 per cent decline. Birth registration data in Delhi for the months of January and February 2021, show an increase in home births, reversing the trend observed in previous years. In the three municipal corporations in Delhi, 35 to 42 per cent of births occurring in January-February 2021 were registered as home births as compared with less than 10 per cent of births registered as non-institutional in 2019. Evidence shows that the risk of postpartum haemorrhage, (PPH) the primary cause of maternal deaths in India, increases in cases of non-institutional births. Institutional deliveries, with skilled health care professionals, have reduced maternal deaths globally. These disruptions highlight the shortcomings of the fragile and unplanned health system and raise questions on the appropriateness of the health policies and programs.

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Lockdowns, fear of becoming infected with COVID-19 and massive disruptions in the provision of maternal health services, such as antenatal and postnatal care and institutional deliveries, have resulted in adverse pregnancy outcomes. The reduction in safe institutional deliveries could be driven by concern about the risk of acquiring COVID-19 in health-care settings, governmental advice to stay at home, or reduced public transport and childcare access during lockdowns. The article in The Lancet reports that in High Income Countries (HIC) routine care was rapidly restructured and delivered remotely, via telephone or video-based appointments.

Although technology can provide a COVID-19-secure path to continuity of antenatal care, there remains inequality of access for people without regular access to high-speed internet or privacy in their living space. In LMICs, where remote consultations are less feasible, some may simply miss out on preventive antenatal care entirely. The impact is greatest on the most disadvantaged groups. Even where care is accessible, potentially harmful policies implemented with little evidence are liable to cause setbacks.

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A study published in the journal Reproductive Health reports that while pregnant women and mothers were not found to be at higher risk for COVID-19 infection than people who are not pregnant, pregnant women with symptomatic COVID-19 could experience more adverse outcomes. They also seem to face disproportionate adverse socio-economic consequences. Severe increases in maternal mental health issues, such as clinically relevant anxiety and depression, were reported. Domestic violence appeared to spike. Women were more likely to lose their income due to the pandemic than men, and working mothers struggled with increased childcare demands. Food insecurity and financial distress due to loss of livelihoods are also likely to have reduced use of maternal health care services.

Urgent measures are required to continue providing high-quality maternal health services during and after the COVID-19 pandemic. These include the need to develop special interventions for pregnant women in emergency situations; establish trust between communities and individuals, particularly frontline health care providers; provide safety equipment, such as personal protective equipment and financial incentives. Further, there is a need to monitor and routinely check-the existing facility service in different hospitals, at both local and community levels as well as private clinics.

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Regulation and strict enforcement are essential so that health care institutions cannot deny providing essential maternal services. Training for health workers – including doctors, nurses and midwives – through online workshops could be initiated to provide antenatal care to patients over mobile phones or other online platforms. Research into the current status of maternal health and services that look into both supply and demand factors and ways to remove barriers to maternal health services amid the COVID-19 pandemic are also required. Special attention to address panic and anxieties about visiting health care facilities is an important supplementary step.
A special focus must be placed on ensuring maternal health services are not disrupted during the ongoing emergency response. Given the existing stresses on health care systems, it is critical that we learn from our experiences in the past year in order to safeguard pregnant women, mothers and their babies against the threats posed by the second wave of the COVID-19 pandemic.

(The article was authored by Poonam Muttreja, Executive Director of the 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

17,66,30,634Cases
5,80,25,717Active
11,47,82,895Recovered
38,22,022Deaths
Coronavirus has spread to 193 countries. The total confirmed cases worldwide are 17,66,30,634 and 38,22,022 have died; 5,80,25,717 are active cases and 11,47,82,895 have recovered as on June 16, 2021 at 3:30 am.

India

2,96,33,105 62,224Cases
8,65,43247,946Active
2,83,88,100 1,07,628Recovered
3,79,573 2,542Deaths
In India, there are 2,96,33,105 confirmed cases including 3,79,573 deaths. The number of active cases is 8,65,432 and 2,83,88,100 have recovered as on June 16, 2021 at 2:30 am.

State Details

State Cases Active Recovered Deaths
Maharashtra

59,24,773 7,652

1,41,440 8,982

56,69,179 15,176

1,14,154 1,458

Karnataka

27,77,010 5,041

1,62,303 9,859

25,81,559 14,785

33,148 115

Kerala

27,48,204 12,246

1,12,792 1,456

26,23,904 13,536

11,508 166

Tamil Nadu

23,78,298 11,805

1,25,215 11,669

22,23,015 23,207

30,068 267

Andhra Pradesh

18,20,134 5,741

75,134 4,879

17,32,948 10,567

12,052 53

Uttar Pradesh

17,03,207 270

7,221 890

16,74,072 1,104

21,914 56

West Bengal

14,68,044 3,268

20,046 1,125

14,30,949 2,068

17,049 75

Delhi

14,31,498 228

3,078 148

14,03,569 364

24,851 12

Chhattisgarh

9,88,172 609

11,717 943

9,63,113 1,544

13,342 8

Rajasthan

9,50,133 172

5,619 848

9,35,658 1,006

8,856 14

Odisha

8,59,526 3,405

44,358 3,436

8,11,780 6,799

3,388 42

Gujarat

8,21,078 352

8,884 658

8,02,187 1,006

10,007 4

Madhya Pradesh

7,88,649 224

3,610 331

7,76,424 528

8,615 27

Haryana

7,66,357 228

3,703 374

7,53,584 564

9,070 38

Bihar

7,17,949 410

4,360 412

7,04,075 813

9,514 9

Telangana

6,06,436 1,556

19,933 528

5,82,993 2,070

3,510 14

Punjab

5,89,153 628

10,802 1,111

5,62,701 1,691

15,650 48

Assam

4,66,590 3,415

41,184 475

4,21,378 2,906

4,028 34

Jharkhand

3,43,793 184

2,646 416

3,36,058 596

5,089 4

Uttarakhand

3,37,449 274

3,642 266

3,26,822 515

6,985 25

Jammu And Kashmir

3,08,726 715

12,407 1,125

2,92,114 1,830

4,205 10

Himachal Pradesh

1,99,197 321

4,050 382

1,91,737 691

3,410 12

Goa

1,63,048 327

4,175 231

1,55,926 548

2,947 10

Puducherry

1,13,192 355

4,668 279

1,06,828 629

1,696 5

Chandigarh

61,200 40

486 21

59,917 58

797 3

Manipur

61,096 785

8,744 301

51,354 476

998 8

Tripura

60,385 536

4,886 65

54,870 596

629 5

Meghalaya

42,759 450

4,430 99

37,579 542

750 7

Arunachal Pradesh

31,938 290

2,849 40

28,934 326

155 4

Nagaland

23,854 101

2,972 229

20,423 327

459 3

Ladakh

19,649 38

552 20

18,898 57

199 1

Sikkim

18,659 209

3,239 67

15,136 273

284 3

Mizoram

15,899 268

3,637 45

12,191 312

71 1

Dadra And Nagar Haveli

10,473 9

61 2

10,408 7

4

Lakshadweep

9,297 61

484 36

8,768 96

45 1

Andaman And Nicobar Islands

7,280 11

105 4

7,049 15

126

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