Covid-19 fuelling mother and child mortality rates
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 the healthy birth weight of 2.5 kg or more.
“When the ambulance didn’t arrive, women got together and delivered the baby 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 the district hospital on May 27, but brought her home because the doctors were busy with (the) corona(virus disease) and didn’t have time for us,” said her father Mithilesh Kor, who is a daily-wage worker.
His baby girl developed fever again and when the ambulance didn’t reach them for the third time in three weeks, the Kors 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 to immunise children because they are doing coronavirus-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 the 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, such as Rewa, Shivpuri, Rewari, Panna, and Shivpuri.
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%. State-level data on institutional births since March is not available.
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 the crisis is missing data. With states busy fire-fighting Covid-19, routine disease surveillance has been hit, creating huge gaps in data on outbreaks.
The Integrated Disease Surveillance Programme (IDSP), which is tasked with tracking outbreaks ranging from seasonal influenza H1N1 to child-killers like diarrhoea, chicken pox and measles, is busy tracking Covid-19 and hasn’t updated its live weekly outbreak dashboard since the end of February. The National Vector-Borne Disease Control Programme, which tracks malaria, chikungunya and dengue, among others, hasn’t received state reports since March.
Routine immunisation is floundering, but it’s difficult to assess the damage in the absence of data. “States haven’t sent immunisation data since the 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, with more than half being from vaccine-preventable and treatable infections, such as pneumonia, diarrhoea and sepsis. 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 the first doses of hepatitis B vaccine that protects against liver infection and cirrhosis. Many others, like her two-year-old brother Piyush, who got immunised at birth have missed booster vaccines since March, which could lead to a resurgence of potentially fatal diseases, such as childhood pneumonia, diphtheria, tetanus, pertussis (whooping cough), hepatitis B and diarrhoea.
This threatens to reverse the gains India has made by immunising children against vaccine-preventing 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 (SRS) data released in June 2019.
“During the monsoons, there is a rise in malaria and vaccine-preventable diarrhoea, pneumonia and measles, which are the biggest cause of under-5 deaths in India. If childhood vaccines are missed, IMR, malnutrition and stunting will rise and prevent India from meeting its Sustainable Development Goal of bringing IMR down to 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 the estimated 3.9 million abortions that would have taken place in this period under normal circumstances,” said Vinoj Manning, chief executive officer, Ipas Development Foundation, a non-profit that promotes safe abortion services in India.
Of the estimated 15.6 million annual abortions in India, 73% are through medical abortion pills that can be bought in pharmacies, 16% are in private health facilities, 6% in public health centres, and 5% through traditional unsafe methods, according to the first large-scale study on unintended pregnancies published in The Lancet in 2017.
“Since medical abortions must be done within 12 weeks of pregnancy (first trimester), the restricted movement and services would have resulted in many pregnant women moving to the second trimester during the lockdown. Very few clinics and hospitals offers abortion services beyond 12 weeks, and the fear of Covid-19 is keeping women away from the ones that do. Add to that the out-of-pocket cost of visiting a hospital at a time of job loss and reduced income, 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 because women don’t have information about safe sex or don’t have access to contraceptives, according to study published The Lancet study. Abortion is legal in India, but three unsafe abortions are performed for every two safe ones because 70% abortion clinics are in urban India, while 70% women live in rural areas, the study found.