Covid-19 fuelling mother and child mortality rates
HIT BY VIRUS With the Centre busy with handling Covid, data compilation, maternal and post-natal care have taken a beating
NEW DELHI: Priyanshi Kol was born in her parent’s one-room hutment in Ansara village in the Rewa district of Madhya Pradesh on May 21 because her mother Shivjanki, 26, couldn’t get an ambulance to reach Sanjay Gandhi Medical Hospital 100 km away. She died on June 13 from childbirth-related complications. She was 23 days old.
Priyanshi was a so-called low-birth baby, weighing 2 kg at birth against healthy birth weight of 2.5 kg or more.
“When the ambulance didn’t arrive, women got together and delivered her at home. Within days, the umbilical cord started bleeding and we called for an ambulance, which didn’t come. We spent Rs 4,000 to take her to district hospital on May 27, but brought her home as doctors were busy with Covid,” said her father Mithilesh Kor, a dailywage worker.
His baby girl developed fever again and when ambulance didn’t reach them for third time in three weeks, they took her to Sanjay Gandhi Memorial Hospital again, where she died.
“My son Piyush was born in a hospital, and he is safe. She would have lived if she had got treated,” said an inconsolable Shivjanki.
“Institutional deliveries have fallen from around 75% to less than 25% in the districts we work in. Since Integrated Child Development Services were suspended on March 15, nutrition and immunisation services have take a huge hit and community health workers stopped visiting homes for immunisation as they are doing Covid-related work.
District-level surveys show 50% children and 75% pregnant women being deprived of essential nutrition in the state,” said Sachin Jain, state coordinator of Bhopal-based non-profit, Vikas Sansad Samiti, which works on issues related to hunger and maternal and child health in the state’s most underserved and largely tribal districts. Around 80.8% births in Madhya Pradesh took place in hospitals in 2015-16, according to the National Family Health Survey-4, compared to the national average of 78.9%.
FALLING IMMUNISATION
As public and private health systems across India geared up to respond to coronavirus disease (Covid-19), they inadvertently did so at the expense of other critical public health services.
This threatens to lead to a parallel explosion in illness and deaths from other preventable and treatable diseases, which will raise all-cause deaths across ages, say experts.
Adding to it is missing data. With states busy fighting Covid-19, routine surveillance has been hit. The Integrated Disease Surveillance Programme (IDSP), tasked with tracking outbreaks ranging from H1N1 to child-killers like chicken pox and measles, is busy tracking Covid and hasn’t updated its live dashboard since February-end.
Routine immunisation is floundering, but it’s difficult to assess damage without data. “States haven’t sent immunisation data since lockdown, but anecdotal evidence indicates there’s been a sharp drop. We have asked states that suspended services to organise catch-up vaccinations drives as soon as possible, with districts with high infant and child mortality, where communities are completely dependent on government services,” said Dr Pradeep Haldar, deputy commissioner, immunisation division, ministry of health and family welfare.
One in five of the world’s 5.9 million under-5 deaths take place in India. If all children are vaccinated after birth, more than half these lives could be saved.
But children like Priyanshi who are born at home also miss three vaccines given at birth -BCG against childhood tuberculosis, oral polio vaccine, and first doses of hepatitis B that protects against liver infection. Many others, like her two-yearold brother Piyush, who got immunised at birth have missed booster vaccines since March.
This threatens to reverse the gains India has made by immunising children against vaccinepreventing illnesses to bring down its infant mortality rate (IMR) to 32 per 1,000 live births in 2018, from 129 in 1971, according to the Sample Registration System data released in June 2019.
“During monsoons, there is a rise in malaria and preventable diarrhoea, pneumonia and measles, which are biggest cause of under-5 deaths in India. If vaccines are missed, IMR, malnutrition and stunting will rise and prevent India from meeting its Sustainable Development Goal of IMR below 25 or less by 2030,” said Dr Dileep Mavalankar, director, Public Health foundation of India Gandhinagar, Gujarat.
UNSAFE BIRTHS, UNSAFE ABORTIONS
Covid-19 has also reduced access to contraception and abortion services, which is likely to lead to an increase in unwanted pregnancies and unsafe abortions. “The first four months of Covid-19, we estimate that access to 1.85 million abortions was compromised. This is around 47% of estimated 3.9 million abortions that would have taken place in this period under normal circumstances,” said Vinoj Manning, CEO, Ipas Development Foundation, a non-profit promoting safe abortion in India.
Of the estimated 15.6 million annual abortions in India, 73% are through medical abortions pills that can be bought in pharmacies, 16% are in private health facilities, 6% in public health centres, and 5% through traditional unsafe methods, as per the first large-scale study on unintended pregnancies published in The Lancet in 2017.
‘VERY FEW CLINICS, HOSPITALS OFFER ABORTION BEYOND 12 WEEKS’
“Since medical abortions must be done within 12 weeks of pregnancy, the restricted movement and services would have resulted in many pregnant women moving to second trimester in lockdown. Very few clinics and hospitals offer abortion beyond 12 weeks, and fear of Covid is keeping women away. Add to that out-of-pocket cost of hospital visit at a time of job loss, and we find many women being forced to continue an unwanted pregnancy or seeking illegal and unsafe abortion services,” said Manning.
An estimated 48% of all pregnancies are unintended as women don’t have information the study in The Lancet says.
OF THE ESTIMATED 15.6 MILLION ANNUAL ABORTIONS IN INDIA, 73% ARE THROUGH MEDICAL ABORTIONS PILLS THAT CAN BE BOUGHT IN PHARMACIES