In Covid times, caring for pregnant women

As the second wave of Covid-19 rages across the country, many vulnerable groups will fall through the cracks as a beleaguered health system tries to cope with the volume of cases. Among these are pregnant women who may or may not be Covid positive. The silver lining is that, so far, there is no conclusive evidence that pregnant women are at any higher risk of complications from Covid infection than anyone else. But there are several issues that pregnant women have to contend with in these trying times.

The pandemic has impacted reproductive health not just through infection but as a result of changing health priorities. Covidrelated studies conducted in both India and China suggest that pregnant women and new mothers are more likely to suffer from mental stress and trauma than others.

This is due to various factors. One, at a time when they need mental and physical support, the constraints imposed by the pandemic lead them to be isolated for fear of infection. There is also the trauma of deaths and infections in their families, which adds to their anxieties about their yet-to-be-born children or, in the case of new mothers, about their infants.

Many pregnant women in India cannot go for check-ups as there is no transport to take them to health centres, especially in remote areas. Many opt not to go for checkups due to fear of getting infected in clinics.

The grassroots health workers who would, in normal times, keep a check on pregnant women and their progress have now been largely pressed into service for Covid-related activities. Many public health centres are shut down and, with them, the availability of supplements for pregnant women has shrunk. In the case of mothers with newborn babies, immunisation in infancy, vital against so many communicable diseases, has been compromised.

Given this dire situation, state governments have to give the care of pregnant women greater attention.

The first step must be enhancing antenatal care through telemedicine wherever possible. There have been reports of pregnant women not being able to access proper care at medical facilities to give birth, forcing them to opt for home births, supervised by untrained persons putting both mother and baby at great risk. This can lead to a rise in maternal and infant mortality.

Pregnancy is a particularly vulnerable time for a woman, both emotionally and physically. What India needs to do is to factor in the special needs of pregnant women within the existing system. Take an example. In the United Kingdom, women in some areas were taught to monitor their own blood pressure at home, something vital in pregnancy. While it may not be possible to supply pregnant women with blood pressure measuring machines in India, it would be useful if grassroots health care workers were to do this and keep a record which can be sent on to clinics for study by a doctor. This can prevent so many complications which arise during pregnancy, which if treated in time, are completely manageable.

Nutrition for the pregnant and lactating mother is another issue of concern as in patriarchal societies like India, women’s needs are not always a priority within the family structure. Supplements such as iron and folic acid must be made available regularly for distribution to homes through the primary health care system. None of these are likely to be a significant drain on resources but if incorporated systematically into the health care system, it will be hugely beneficial to pregnant women during the pandemic and in the future.