Authors:

Archana Arora – Welfare Officer at Welfare Home For Children, Sarita Vihar – M.S.W in Disability Studies and Action (TISS, Mumbai)

Anurag Shankar – Program Manager at Amar Jyoti Charitable Trust, Karkardooma – M.S.W in Criminology and Justice (TISS, Mumbai)

Introduction:

Maternal Health

According to the World Health Organization, “Maternal health refers to the health of women during pregnancy, childbirth and the postnatal period. It should ensure women and their babies reach their full potential for health and well-being.” [1]

Every pregnancy and birth is unique. Addressing inequalities that affect health outcomes, especially sexual and reproductive health and rights and gender, is fundamental to ensuring all women have access to respectful and high-quality maternity care.

Although important progress has been made in the last two decades, about 295000 women died during and following pregnancy and childbirth in 2017. This number is unacceptably high.

“Maternal Mortality Ratio of India has declined still in every 20 minutes a mother dying due to pregnancy or childbirth related cause”

Approximately 810 Women die every day from preventable causes related to pregnancy and childbirth. –UNICEF

Meaning of COVID- 19

According to WHO, Coronavirus illness (COVID-19) is an infectious disease brought about by a newfound Covid. The vast majority contaminated with the COVID-19 infection will encounter mellow to direct respiratory ailment and recuperate without requiring exceptional treatment. More established individuals, and those with clinical issues like cardiovascular ailment, diabetes, interminable respiratory infection, and disease are bound to create genuine ailment. [2]

As per UNESCO, the COVID-19 outbreak is a global public health crisis. It tells us scientific cooperation is the key when dealing with a global public health issue. It is a stark reminder of the importance of quality, reliable information, at a time when rumours are flourishing. It tells about the power of culture & knowledge to strengthen human fabric and solidarity, at a time when so many people around the world must keep social distance and stay at home. [3]

India already faces a severe fitness group of workers shortage, and has plenty under the WHO benchmark of 22.. Increased workload, re-mission of group of workers to deal with COVID-19 sufferers and lack of group of workers because of contamination or quarantine, pose severe stress at the capability to preserve the sexual, reproductive, maternal, new-born and child health (SRMNCAH) services. Any diversion of professional carriers of maternal and new child care to COVID-19 reaction paintings have to be discouraged.[4]

Impact of COVID-19 on Maternal Health

Improving the wellbeing and nourishment of mothers to-be and giving quality maternal and new-conceived wellbeing administrations through a continuum of care approach. This incorporates improving admittance to family arranging, antenatal consideration during pregnancy, improved administration of ordinary conveyance by gifted specialists, admittance to crisis obstetric and neonatal consideration when required, and opportune postnatal consideration for the two moms and infants.

The COVID-19 pandemic is posing considerable challenges for countries to maintain the provision of high quality, essential maternal and newborn health services.  Countries grappling with the pandemic may need to divert significant resources, including midwives, from regular service delivery to response efforts.  And, pregnant women and mothers with newborns may experience difficulties accessing services due to transport disruptions and lockdown measures or be reluctant to come to health facilities due to fear of infection.

The safest place for a woman to deliver her baby is at a functional health facility with a skilled birth attendant. However, during this global crisis many women may end up delivering at home without appropriate support.   Countries and their partners must work together to ensure antenatal, childbirth and postnatal care services are kept available 24 hours a day 7 days a week throughout every stage of the pandemic.

All pregnant women—including those with suspected or confirmed COVID-19—should continue to attend antenatal care visits and deliver with a skilled health provider to optimize healthy outcomes for both themselves and their newborns.  And, given the vulnerability of newborns during the first days of life, postnatal care services for mothers and their babies must continue to be prioritized.  The full extent of COVID-19’s impact on economies, societies and health is still unknown and unfolding every day.  Yet, if life-saving interventions are disrupted, many more mothers and newborns could die from treatable and preventable conditions. Investments in health systems must be made to enable countries to both adequately respond to the pandemic and ensure the continuity of critical maternal and newborn health services and supplies.[5]

Policy/Programmes and schemes on Maternal Health in India 

The Government of India adopted the Reproductive, Maternal, New-born, Child and Adolescent Health (RMNCH+A) framework in 2013, It essentially aims to address the major causes of mortality and morbidity among women and children. This framework also helps to understand the delays in accessing and utilizing health care services.

Based on the framework, comprehensive care is provided to women and children through five pillars or thematic areas of reproductive, maternal, neonatal, child, and adolescent health. The programmes and strategies developed by various divisions are guided by central tenets of equity, universal care, entitlement, and accountability to provide ‘continuum of care’ ensuring equal focus on various life stages.

Ministry of Health & Family Welfare, Government of India has launched a new initiative namely- “SUMAlV- Surakshit Matritva Aashwasan” with an aim to provide assured, dignified, respectful and Quality healthcare at no cost and zero tolerance for denial of services for every woman and newborn visiting the public health facility in order to end all preventable maternal and newborn deaths and morbidities and provide a positive birthing experience. The expected outcome of this new initiative is “Zero Preventable Maternal and Newborn Deaths and high quality of maternity care delivered with dignity and respect”. Following this strategy, the Maternal Health Division strives to provide quality services to pregnant women and their newborns through various interventions and programmes, building capacity of health personnel and routine health systems strengthening activities.

According to the latest figure released by Registrar General of India – Sample Registration System (RGI-SRS) Maternal Mortality Ratio (MMR) for the period 2014-16 is 130 maternal deaths per 100,000 live births.  With this, India has achieved the Millennium Development Goal (MDG) 5 i.e. India has achieved a reduction in MMR by three quarters from 1990 to 2015. The target was to achieve 139 maternal deaths per 100,000 live births.  The table displays the trend in MMR over the years.  The average decline in MMR between 2007-09 and 2011-13 had been 11.3 points per year, i.e. compound rate of annual decline was 5.8% whereas average compound rate of decline is 8% between 2011-13 and 2014-16.

Flagship Schemes and programs

JananiSurakshaYojana (JSY): JananiSurakshaYojana (JSY), a demand promotion and conditional cash transfer scheme was launched in April 2005 with the objective of reducing Maternal and Infant Mortality. It is being implemented with the objective of reducing maternal and neonatal mortality by promoting institutional delivery among poor pregnant women.

JananiShishuSurakshaKaryakram(JSSK): Government of India has launched JananiShishuSurakshaKaryakaram (JSSK) on 1st June, 2011, which entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery including Caesarean section. The initiative stipulates free drugs, diagnostics, blood and diet, besides free transport from home to institution, between facilities in case of a referral and drop back home. Similar entitlements have been put in place for all sick new-born accessing public health institutions for treatment till 30 days after birth. In 2013, this has been expanded to sick infants and antenatal and postnatal complications.

Pradhan MantriSurakshitMatritvaAbhiyan (PMSMA): Carrying forward the vision of our Honorable Prime Minister, the Pradhan MantriSurakshitMatritvaAbhiyan was launched in 2016 to ensure quality antenatal care and high risk pregnancy detection in pregnant women on 9th of every month.

LaQshya: In order to further accelerate decline in MMR in the coming years, MoFHW has recently launched ‘LaQshya – Labour room Quality improvement Initiative. LaQshya program is a focused and targeted approach to strengthen key processes related to the labour rooms and maternity operation theatres which aims at improving quality of care around birth and ensuring Respectful Maternity Care.

Comprehensive Abortion Care Services: Comprehensive and safe abortion services are provided at public health facilities including 24*7 PHCs/ FRUs (DHs/ SDHs /CHCs) including the Delivery Points. Supply of Nischay Pregnancy detection kits to sub centres for early detection of pregnancy is undertaken. District Level Committees (DLCs) have been framed and empowered for accreditation the facilities for conducting safe abortion services under MTP Act including approval of private and NGO sector facilities for conducting MTPs.

Midwifery – Government of India has initiated midwifery services throughout the country in 2018, with an objective to provide access to quality maternal and neonatal health services, to promote natural birthing, to ensure respectful care and to reduce over medicalization. The Midwifery services initiatives aim to create a cadre for Nurse Practitioners in Midwifery who are skilled in accordance to ICM competencies, knowledge and capable of providing compassionate women – centric pregnancy care.

Impact

As per UNICEF, “pregnant women and mothers with newborns may experience difficulties accessing services due to transport disruptions and lockdown measures or be reluctant to come to health facilities due to fear of infection.”[6]

  • Compounded economic impacts are felt especially by women and girls who are generally earning less, saving less, and holding insecure jobs or living close to poverty.
  • While early reports reveal more men are dying as a result of COVID-19, the health of women generally is adversely impacted through the reallocation of resources and priorities, including sexual and reproductive health services.
  • Unpaid care work has increased, with children out-of-school, heightened care needs of older persons and overwhelmed health services.
  • As the COVID-19 pandemic deepens economic and social stress coupled with restricted movement and social isolation measures, gender-based violence is increasing exponentially. Many women are being forced to ‘lockdown’ at home with their abusers at the same time that services to support survivors are being disrupted or made inaccessible.
  • All of these impacts are further amplified in contexts of fragility, conflict, and emergencies where social cohesion is already undermined and institutional capacity and services are limited. [7]                                                                                                                                  

Rationale of the study

There are a very less number of research studies on this topic. The pandemic has adversely affected each and every one, so this study would highlight on the issue faced by the pregnant women or the newly mothers.

Recommendations 

The government should look at expanding partnerships with private sector distribution points, such as pharmacies, drug shops and non-traditional outlets (e.g, district kiosks and service centres) that offer modern contraceptives, maternal and newborn life-saving drugs and supplies, maternal health equipment etc in maintaining adequate stocks and ensuring uninterrupted supply of SRMNCAH services . All instalments related to schemes like Janani SurakshaYojana and Pradhan Mantri Matru VandanaYojana, and IFA tablets can be given in advance to maintain continuity in maternal nutrition.

In times of psychological and emotional upheavals, it is equally important to remodel the traditional patterns of communication. Substituting personal contact with easily accessible, simplified, virtual communication (for example integrating SRMNCAH information in the widely downloaded Aarogya Setu app) and leveraging the community networks and panchayats by conducting multiple workshops for health promotion activities, IEC campaigns, meetings of the Village Health Sanitation and Nutrition Committees/Mahila Arogya Samitis etc should be encouraged. The aim is to deal with behavioural changes for creating demand health-seeking behaviour of pregnant, lactating women and caregivers. Hence, a well-managed system that allows pregnant women to access maternal health care with minimum exposure risk is essential during the outbreak.[8]

 Methodology

Research methodologies are the specific procedures or techniques used to identify select, process and analyse information about a topic. The methodology section allows the reader to critically evaluate a study’s overall validity and reliability.

Objectives of the study-

  1. To explore the impact of COVID-19 and understand the challenges faced by the mothers and the newborn children.
  2. To identify the support provided by the government schemes and programs to the pregnant women in times of COVID-19.

Selection of the Sample –

Quantitative research has been used and the process of sampling used to conduct the study is Convenience Sampling.

Criteria for Selection of the Sample- 

The woman should be a newly mother or a pregnant woman irrespective of the age group .

Sample size and method-

Questionnaire method was used by the researcher and data was collected from 15 respondents.

Ethical Considerations

The research was transparent about the study and had explained the objectives of the study and the rationale behind the study with the mothers and their children. Care has also been taken to see that the questions asked during the questionnaire do not cause any form of harm to the relationships of the respondents with their family or the child. They were assured fully that their responses would be treated with absolute confidentiality.

Analysis

Age, Educational status– Profile

Figure 1.1 – Depicting the age of the respondents

The maximum number of the respondents belonged to the age group of 30-35 years which comprised the 47% of the total respondents followed by respondents belonging to the age group of 25-30 years comprised of 44% and 7% of the respondents belonged to the age group from 20-25 years.

Figure 1.2- Depicting the educational qualifications of the respondents

From the given bar graph, the percentage of the Graduate and Post- Graduate respondents is equal which is 33.3% followed by 12th pass respondents which is 26.7%. Only 6.7% of the total respondents are PhD.

Figure 1.3- Depicting the family type of the respondents

From the above pie chart, it is clear that the majority of the respondents live in nuclear families comprising 67% whereas nearly 33% of the respondents live in joint families.  Through our study, we can analyse how our family structures are changing rapidly.

Figure 1.4 – Distance of hospital far from home

The pie chart displays the distance of the health care institution like hospital, clinic, PHC from the respondent’s house. About 53% of respondents have a reach to the nearest health care institution in the radius of 2-5 km whereas 47%  of the respondent’s house is 5-10 kms far away from the nearest hospital.

It can be analysed from the above bar graph that the majority of the healthcare professionals and staff members showed a very uncooperative and obstructive behaviour towards the patients and their family members. This attitude and behaviour of the hospital staff is surely detrimental and pernicious to the healthcare institutions and maligns the noble profession of health care.

From the above pie chart it can be clearly analysed that the majority of the respondents were not aware or had heard about the varied maternal health services being provided by the government. Somewhere the government is responsible here as respondents from the major cities of the country are not aware about the government schemes and programs which should be a reason of serious concern. The government should work more on the aspect of community reach and awareness at all levels.

Figure – Sources about the services  

It can be analyzed the importance and use of the internet these days. As it has been the major source (44%) constituting to seek information about the maternal health services followed by the hospital staff i.e 26% and television 2%. While the least source of information 4% from newspapers and government websites.

Figure- Depicting the data on Schemes benefits

The above data is again a major reason of concern as only 40 percent of the total respondents were able to seek the benefit of the government schemes like PM MantriMatruYojana, PM MantriMatruVandanaYojana and other programmes.

The above data shows that the majority of the respondents preferred to avail the services of a private hospital instead of going to a government hospital. It can be clearly analysed that in what conditions our government health care systems are functioning and due to their malfunctioning, the respondents prefer to go to private hospitals or clinics for the delivery of a child.

The above charts indicate that most of the respondents could not meet the criteria to avail the money under JananiSurakshaYojana. Only around 10-12 percent of the respondents availed the benefit of JananiSuraksha Scheme.

From the above pie chart, it can be analysed that 53 percent of the respondents were affluent and were able to afford the maternity services whereas 47 percent of the respondents were dependent on the government’s maternity schemes and programs.

The above data shows that how COVID-19 led to facing numerous issues by pregnant women or the newly mothers. 54% of the pregnant women or the newly mothers feared the risk of getting affected from the COVID 19 which further impacted their mental health after  being isolated and feeling of distress and despair was evidently analysed whereas 32% pregnant women or the newly mothers were afraid to go to the doctor for their regular check-ups and tests due to COVID 19 pandemic.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3484741/

[2] https://www.who.int/health-topics/coronavirus#tab=tab_1

[3] https://en.unesco.org/covid19

[4] https://indianexpress.com/article/opinion/covid-19-and-demand-for-maternal-health-services-6410678/

[5] https://www.unicef.org/india/what-we-do/maternal-health

[6] https://data.unicef.org/topic/maternal-health/covid-19/

[7]https://www.un.org/sexualviolenceinconflict/wp-content/uploads/2020/06/report/policy-brief-the-impact-of-covid-19-on-women/policy-brief-the-impact-of-covid-19-on-women-en-1.pdf

[8] https://indianexpress.com/article/opinion/covid-19-and-demand-for-maternal-health-services-6410678/

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