Even C-sections have fallen! How COVID-19 is hitting childbirths too
NEW DELHI/ LUCKNOW/ MUMBAI/ JAIPUR: When Sarika (name changed), 27, a woman in Uttar Pradesh's Meerut felt sharp labour pains suddenly 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 the doctor's advice since the chances of contracting COVID-19 virus seemed higher in a government centre teeming with people," Sarika's husband Pawan Kumar (name changed), who teaches in a primary school, told this correspondent over phone.
Sarika delivered a baby girl on April 29, helped by a woman, a retired auxiliary nurse midwife.
"I never wanted it this way but I am thankful that there was no complication and myself 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 are either forced or choose to deliver at home without expert and experienced medical supervision.
Thousands of them will die too, due to complications during the childbirth.
A look at the Health Management Information System, maintained by the Union Ministry of Health and Family Welfare, suggests that in March this year -- when a nationwide lockdown was enforced in order to contain the COVID-19 spread -- institutional deliveries dropped by 43 per cent over March last year.
The number of childbirths registered in hospitals -- public and private -- across India stood at 1717500 in March last year while this year the number dropped to 971782.
The differences are equally stark in the case of Caesarian Sections, which may be absolutely essential and life-saving in 5-15 per cent of all childbirths. They dropped by over 46 per cent in March, as compared to March last year.
The data for April, when the country was under a very strict lockdown, is not available yet but the figures from March have set the tone for even more worrying figures that the coming weeks will throw.
The figures suggest the monthly institutional deliveries in March this year may have been the lowest in many many years.
States confirm the worrying dip in the numbers.
In Lucknow, authorities say that though the maternity hospitals were functioning throughout the lockdown period, the number of expectant mothers coming for a follow-up or even deliveries fell by around 20 per cent both in public and private hospitals.
In Rajasthan, data suggests that every month in about 2200 primary and community health centres and 1100 private hospitals, nearly 1.5 lakh births were registered last year but this figure has fallen by almost half during the lockdown period.
"The figures are very alarming and while some of this could be explained by issues in reporting, the COVID-19 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 efforts in ensuring safe deliveries by about 15 years."
Sulakshna Nandi of Jan Swasthya Abhiyan said that 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 because hospitals have denied them admission," she said. "Many essential healthcare services have been hit during the COVID-19 outbreak and pregnant women are among the worst hit."
It was for this reason that last month, the Delhi-based Sama group filed a PIL in Delhi High Court 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 seeking essential health services.
The court directed the government too, but on the 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, the public health system in the country has a limited capacity in several states even during normal times and now in the times of a pandemic, we are seeing it overwhelmed," she added.
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 sectors for a majority of our needs but today with most of them either shut or denying services to patients, 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 JJ Hospital, for example, 600 women gave birth this April as compared to April last year when this number was 350.
"There are non-registered pregnant women who could not avail any other options also turning up," said Dr Ashok Anand from the hospital.