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

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

22,81,49,892Cases
19,07,93,163Active
3,26,71,167Recovered
46,85,562Deaths
Coronavirus has spread to 195 countries. The total confirmed cases worldwide are 22,81,49,892 and 46,85,562 have died; 19,07,93,163 are active cases and 3,26,71,167 have recovered as on September 19, 2021 at 3:52 am.

India

3,34,48,163 30,773Cases
3,32,1588,481Active
3,26,71,167 38,945Recovered
4,44,838 309Deaths
In India, there are 3,34,48,163 confirmed cases including 4,44,838 deaths. The number of active cases is 3,32,158 and 3,26,71,167 have recovered as on September 19, 2021 at 2:30 am.

State Details

State Cases Active Recovered Deaths
Maharashtra

65,18,502 3,391

51,472 530

63,28,561 3,841

1,38,469 80

Kerala

44,88,813 19,325

1,81,411 8,084

42,83,963 27,266

23,439 143

Karnataka

29,67,083 889

15,783 205

29,13,713 1,080

37,587 14

Tamil Nadu

26,43,683 1,653

16,893 50

25,91,480 1,581

35,310 22

Andhra Pradesh

20,37,353 1,174

14,653 144

20,08,639 1,309

14,061 9

Uttar Pradesh

17,09,652 9

193 2

16,86,572 7

22,887

West Bengal

15,61,014 728

7,967 41

15,34,406 757

18,641 12

Delhi

14,38,469 41

404 3

14,12,980 44

25,085

Odisha

10,19,621 695

5,929 689

10,05,564

8,128 6

Chhattisgarh

10,05,042 28

332 14

9,91,150 42

13,560

Rajasthan

9,54,246 8

102 2

9,45,190 10

8,954

Gujarat

8,25,715 13

143 11

8,15,490 24

10,082

Madhya Pradesh

7,92,386 6

97 12

7,81,772 18

10,517

Haryana

7,70,711 6

323 0

7,60,580 6

9,808

Bihar

7,25,881 10

65 0

7,16,158 10

9,658

Telangana

6,63,281 255

5,148 75

6,54,230 329

3,903 1

Punjab

6,01,236 30

316 7

5,84,453 23

16,467

Assam

5,97,709 365

5,063 102

5,86,856 465

5,790 2

Jharkhand

3,48,114 3

74 20

3,42,907 23

5,133

Uttarakhand

3,43,376 21

282 0

3,35,704 20

7,390 1

Jammu And Kashmir

3,27,773 152

1,479 39

3,21,878 113

4,416

Himachal Pradesh

2,16,813 174

1,610 30

2,11,554 142

3,649 2

Goa

1,75,414 123

771 40

1,71,351 81

3,292 2

Puducherry

1,25,384 128

924 5

1,22,631 122

1,829 1

Manipur

1,18,261 140

2,180 92

1,14,251 228

1,830 4

Tripura

83,840 31

367 37

82,665 67

808 1

Meghalaya

79,325 119

1,876 76

76,075 192

1,374 3

Mizoram

79,171 1,104

14,456 161

64,456 938

259 5

Chandigarh

65,176 4

35 1

64,323 3

818

Arunachal Pradesh

54,060 32

461 44

53,328 76

271

Sikkim

30,893 54

728 28

29,786 82

379

Nagaland

30,840 60

491 20

29,696 39

653 1

Ladakh

20,702

109 0

20,386

207

Dadra And Nagar Haveli

10,670

1 4

10,665 4

4

Lakshadweep

10,356

6 1

10,299 1

51

Andaman And Nicobar Islands

7,598 2

14 0

7,455 2

129

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