As we know the pandemic has had destructive effects on everyone’s life. Scientists, researchers and public health professionals are working hard to map, measure and report on the short and long term scientific, 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 amid the ‘focused priorities’ for addressing COVID19. One such domain is the world of maternal and child health.
The data show that COVID19 is most dangerous for elderly persons and for those with underlying health conditions, especially heart disease, hypertension, and obesity. It is good that pregnant women are not at higher risk of developing COVID19 complications and that transmission to the foetus during pregnancy is unlikely (Kotlar 2020). Nevertheless, in countries with poor public health facilities, any warlike efforts to deal with COVID19 only result in exacerbating the already pathetic situation of maternal and child health, more specifically of pregnant mothers.
In India the National Family Health Surveys have amply demonstrated that antenatal checkups can reduce health risks for mothers and their babies by screening for complications and intensive care. Antenatal checkups were found to reduce maternal and perinatal morbidity (around the time of birth) and mortality, directly and indirectly through the detection and treatment of pregnancy related complications. They help identify 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). Yet only 62% of pregnant women worldwide received full antenatal care in recent years (UNICEF 2018). In India only 51% of women received full antenatal care (NFHS 2015-16). This is the situation for a free public health facility. Full antenatal checkups include: blood tests, screenings, tetanus toxide injections, iron-folic acid tablets and counselling. The data reflect how even in normal days pregnancy is not a matter of health concern, requiring frequent visits to a medical facility. It is perceived as a normal social phenomenon, and only in emergencies is a medical facility preferred. Thankfully conditions have changed in India, as back in 2005-06 the proportion of women who received full antenatal care was only 37% (NFHS-3).
The frontline health workers of the National Health Mission, who earn additional incentives for identifying, reporting and ensuring the safe passage of mothers from pregnancy to childbirth, have come up as an important link for promoting antenatal checkup services. Are pregnant mothers feeling uneasy on account of COVID19? More simply, are women facing any problems regarding antenatal care due to it?
Being a public health researcher, fixed under lockdown and located in a COVID19 hotspot, I thought to ‘talk’ and reflect on the issues of pregnant mothers in a similar situation. The respondents are the women of Haldwani city, Uttarakhand who are under lockdown in localities declared infection hotspots. Two women shared that even after the union government declared the nationwide lockdown, they visited their public health facility for a routine antenatal checkup, but there weren’t enough staff so they faced a lot of problems, and were not satisfied with the antenatal checkup. One woman in her fifth month of pregnancy wanted to consult the doctor at a health facility but could not go due to the lockdown. She thinks that if she goes to the hospital during lockdown, the police will take her to the local quarantine centre. Three women categorically said that there was no need to go to the hospital because the virus may infect them. To them now the hospital is the riskiest place. A woman shared that at a private hospital the doctor suggested she get an ultrasound. According to the ultrasound report she needed some internal examination but the doctor only prescribed her some medicine and did not examine her. She asked why, and the doctor replied that due to Coronavirus spread she cannot take the risk of examining her, saying she could either take these medicines or go to another hospital or doctor.
If the doctors also maintain physical (social) distancing from normal patients how will they treat them? Thus even before the onslaught of the pandemic there had started distancing from patients. Given the health infrastructure, facilities and protection usually at the disposal of doctors at the public and private health facilities in suburban areas, one can understand the situation. It is a precarious situation where we are struggling to promote positive behaviour change for availing and utilising maternal and child health services. Any apathy today will only exacerbate the post-COVID stigma with regard to medical 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 it and beyond, there is a need to work together to ensure that maternal well being is not ignored. The withholding of antenatal care has crucial consequences for both the mother and her baby. Without healthcare practitioners no one can help improve maternal and child health. Already there is public apathy in considering pregnancy and childbirth as critical health issues, and any further apathy or stigma at health facilities will 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 strategies for the present and future pandemics. There is a need for clear and specific mention on considering maternal and child health services as a separate ‘constituency’ deserving priority even during public health emergencies like COVID19. Rather, during the pandemic situation it becomes all the more important to prioritise the care of pregnant mothers and mothers nearing childbirth. These public health issues must not be ‘missed’ but founded as issues of top priority.