Deaths without medical attention surged in 2020
Fewer women gave birth in institutional settings amid pandemic
AThe data shows only around 28% of people who died in 2020 received some attention from a medical institution
round 45 out of every hundred people whose deaths were captured in government data died without receiving medical attention in the pandemic-hit 2020.
This was 10.5 percentage points higher than the 34.5 per cent figure recorded for such deaths in 2019, the year before the pandemic (see chart 1). The deaths captured in the government’s annual report on Vital Statistics of India, based on the Civil Registration System, include all causes — Covid-19 and others. The data shows that only around 28 per cent of people who died in 2020 received some attention from a medical institution. Another 16.4 per cent received non-institutional medical attention; 0.8 per cent were attended to by a qualified medical practitioner; and 0.5 per cent by those practising alternative systems of medicine. The rest fell under others or had no data available.
A perusal of earlier reports shows that the number of people who died without receiving medical attention was lower before 2015. For example, it was under 20 per cent in 2011 and 2012. This may have to do more with the fact that registrations don’t capture all deaths.
Data collection issues have come down of late, according to a 2019 study entitled “Completeness of death registration in the Civil Registration System, India (2005 to 2015)” by G Anil Kumar, Lalit Dandona and Rakhi Dandona of the Public Health Foundation of India.
“The completeness of registration of death (CORD) in the Indian Civil Registration System (CRS) was assessed from 2005 to 2015… About 40 per cent increase in CORD was documented for India between 2005 and 2015, with CORD of 76.6 per cent in 2015,” it said.
Dileep Mavlankar, director, Indian Institute of Public Health, and former professor, Indian Institute of Management Ahmedabad, suggested that any fall in availability of medical assistance once the registration data is uniform would indicate lack of health infrastructure or poverty issues.
A similar trend of lack of access to medical facilities was also seen during births. Only 74 out of 100 women who gave birth did so in an institutional setting, like a government or private hospital, in 2020, compared to 81 in 2019 (see chart 2).
Giving birth in a hospital setting reduces the chances of the mother dying during childbirth, noted a 2021 study entitled “Effects of Covid-19 on maternal institutional delivery: Fear of a rise in maternal mortality” by Rahman M A of Khulna University in Bangladesh, Henry Ratul Halder of the University of Manitoba in Canada and Sheikh Mohammed Shariful Islam from Deakin University in Australia. The study noted that every day, there are 810 maternal deaths globally, most of which can be prevented through safe institutional delivery.
“In 2019, about 80 million deliveries occurred at health institutions globally, but this number may be reduced in a post-pandemic scenario. Pregnant women who deliver at home have an increased risk of maternal mortality… Evidence shows that 35 per cent of all causes of antepartum, intrapartum and postpartum haemorrhage is due to unsafe home delivery practices,” the study said.
A regional breakdown shows that the registration of both births and deaths still happens with a lag in many states. Fifty per cent or fewer births are registered within the prescribed 21 days in Uttar Pradesh, Manipur, Uttarakhand, Ladakh, Assam, Arunachal Pradesh and Nagaland. The same is the case with deaths in Uttar Pradesh, Uttarakhand, Jammu and Kashmir, Nagaland, Manipur, Ladakh, Assam and Arunachal Pradesh.