The entire world is battling COVID-19 virus and the World Health Organization has declared COVID-19 as a public health emergency. The mortality and morbidity on account of this pandemic have exceeded the lives lost during the Second World War. The figures of COVID-19 infection and deaths are still on an upward swing. According to the latest update of WHO, the worldwide death toll has risen to 298000 and the number of people infected with the virus rose to 4.3 million. In India, the number of death stands at around 2500 and positive cases at 78000.
As we know the COVID-19 pandemic has devastating effects on everyone’s life. The scientists, public health professionals and researchers have been working hard to map, measure and report on the short and long term scientific, public health and social effects of this pandemic. However, there are still many areas which are very sensitive and could be badly affected on account of the pandemic but are usually missed in terms of ‘focused priorities’ to address COVID-19. One such domain is the world of maternal and child health. The existing data shows that COVID-19 is most dangerous for elderly persons and for people with underlying health conditions, especially heart disease, hypertension, and obesity. It is assuring to see that pregnant women are not at a higher risk of developing COVID-19 complications and that transmission to the foetus during pregnancy is unlikely (Kotlar, 2020). Nevertheless in the countries with poor health facilities and infrastructure, the warlike efforts to deal with COVID-19 only result in exacerbating the already pathetic situation of the maternal and child health and more specifically of the pregnant mothers.
In the Indian context, the national health survey has amply demonstrated that antenatal checkups (ANC) can reduce the health risks for mothers and their babies by screening for complications and intensive care (NFHS-4). ANC reduces maternal and perinatal morbidity and mortality both directly and through detection and treatment of pregnancy-related complications indirectly. It helps in the identification of pregnant women at increased risk of developing complications during labour and delivery and improving the underlying health conditions, thus ensuring referral to an appropriate level of care (WHO, 2016). Worldwide, only 62% of pregnant women received full antenatal care (UNICEF, 2018). In India, only 51.2% of women received full antenatal care (NFHS-4, 2014). This is a free public health facility and the full ANC includes-blood tests, screenings, Tetanus Toxide (TT) injections, Iron-Folic Acid (INFA) Tablets and counseling. The data is reflective of how even in the normal days the pregnancy is not a matter of health concern requiring frequent visits to the health facility. It is perceived as a normal social phenomenon and only in an emergency, the health facility is preferred. In India, the conditions have changed as the percentage of women receiving full antenatal care was only 37% in NFHS-3, 2005-06. Further as a result of national health missions’ frontline health workers, with add-on incentive in identifying, reporting and ensuring the safe passage of mothers from pregnancy to childbirth have come up as an important link for promoting ANC services.
Are the pregnant mothers feeling uneasy on account of COVID-19? More simply, are the women facing any problem regarding antenatal care due to the COVID-19?
Being a public health researcher, under lockdown and located in a COVID-19 hotspot, I thought of ‘talking’ and reflecting on the issues of pregnant mothers in a similar situation. The respondents are the women of Haldwani city (Uttarakhand, India) who are under lockdown and whose locality is declared as a COVID-19 hotspot.
Two women shared that after the government declared the nationwide lockdown, they visited the public health facility for a routine antenatal checkup but there were not enough staff members so they faced a lot of problems and were not satisfied with the antenatal checkup.
One woman shared that she was in her 5th month of pregnancy and wanted to consult a doctor at a health facility but could not go due to lockdown. She thought that if she visited the hospital during lockdown the police would take her to a quarantine center.
Three women categorically said that there was no need to go to the hospital because the virus might infect them. To them the hospital is the riskiest place now.
One woman shared that she went to a private hospital and the doctor suggested an ultrasound. After the ultrasound, she went back to the hospital. According to the ultrasound report, she needed internal examination but the doctor prescribed some medicine to her and did not examine her. When she asked the doctor why she was not examining her, the doctor replied that due to the spread of coronavirus she could not take the risk of examining her. The doctor said to the woman that she could either take those medicines or go to another hospital or doctor.
If the doctors maintain physical (social) distancing from the normal patients, how will they treat them? Even before the onslaught of the pandemic, the doctors started distancing themselves from the patients. Given the health infrastructure, facilities and protection usually at the disposal of the doctors at the public and private health facilities in suburban areas, one can understand the situation. This is a precarious situation where we are struggling to promote positive behaviour change for availing and utilizing maternal and child health services. Any apathy today will only exacerbate the post-COVID-19 stigma regarding health facilities and promoting better antenatal and postnatal services.
This is a very difficult time for everyone, and we need to focus on weathering the current crisis. In this crisis, and beyond, there is a need to work together to ensure that maternal well-being is not ignored. Antenatal care, if not provided, has crucial consequences for both the mother and her baby. Without health care practitioners no one can help to improve maternal and child health. If the doctors are not willing to see the patients, how can they improve the maternal and child health? In the country-specific scenario wherein there is already public ignorance to consider pregnancy and childbirth as critical health issues, any further apathy and stigma at health facility shall only aggravate the situation.
There is a need for an urgent policy attention to include the ‘missed constituencies’ like maternal and child health in planning and executing the strategies for pandemics like COVID-19. There is a clear and specific need to consider the maternal and child health services as a separate constituency deserving priority even during the public health emergencies like COVID-19. Rather during the pandemic situation, it becomes all the more important to take on priority the care of pregnant mothers and mothers nearing childbirth. We need to understand that pregnancy and childbirth are critical public health issues and in the unfortunate event of a pandemic these must not be ‘missed’ but positioned as priority issues.
Afsana, Research Scholar, Department of Social Work, Maulana Azad National Urdu University, Hyderabad. Email: firstname.lastname@example.org
Cafe Dissensus Everyday is the blog of Cafe Dissensus magazine, based in New York City and India. All materials on the site are protected under Creative Commons License.
Read the latest issue of Cafe Dissensus Magazine, “Poetics and politics of the ‘everyday’: Engaging with India’s northeast”, edited by Bhumika R, IIT Jammu and Suranjana Choudhury, NEHU, India.