New Delhi: When Madhu, a resident of Kangra valley in Himachal Pradesh, got the news of her pregnancy in December, she was both happy and relieved. The 31-year-old had suffered a miscarriage once, and undergone nearly three years of in-vitro fertilisation (IVF) treatments.
But the joy soon turned into anxiety. Four months into the pregnancy, Madhu found herself panicking, as she couldn’t get all her medicines at the local chemists as the Covid-19 pandemic struck in March. She, somehow, reached Chandigarh along with her husband, and has been staying there since.
Unavailability of medicines, travel restrictions and lack of proper healthcare facilities amid the nationwide lockdown to combat Covid-19 have left pregnant women anxious across the country.
While the norms have been eased for healthcare facilities, under new lockdown guidelines issued earlier this week, private clinics and out-patient departments (OPDs) in hospitals had been for the larger part of the shutdown leading to a grim situation on the ground.
The government had attempted to address the situation when Union Health Minister Harsh Vardhan said on 10 April “states need to be mindful that the treatment or medical needs of pregnant women, dialysis patients and those suffering from Thalassemia are attended to”.
But a senior official in the Ministry of Health and Family Welfare, requesting anonymity, said, “Given the amount of blood loss during pregnancy and lack of availability of experts with more deliveries at home, especially in the lower middle class, during the lockdown, we are worried that the maternal deaths will increase.”
The official said a review meeting will be held soon in this regard.
India currently has a birth rate of 17.592 births per 1,000 people.
According to the Sample Registration System 2015-17 bulletin released in November 2019, the infant mortality rate is 33 per 1,000 live births and the maternal mortality rate (MMR) is 122 per 1 lakh live births in 2015-17. Both are expected to rise due to the pandemic.
At a time like this, states, especially the ones with poorest SRS records, are expected to keep stringent restrictions in place at a time the coronavirus cases are rising.
Madhya Pradesh, for example, has repeatedly (15 times) reported the highest infant mortality rate in the country, according to the SRS data. Of every 1,000 children born in the state, 47 die before their first birthday. Indore in MP is emerging as one of the worst affected Covid-19 hotspots.
Lack of proper healthcare during the lockdown could have a bearing on the maternal mortality rate also. In India, about 30 per cent of pregnancies come under the high risk category.
According to the SRS bulletin, the percentage of live births where mothers received medical attention during delivery either at a government or private hospital rose from 73.1 in 2012 to 81.9 in 2017.
The latest guidelines issued by the Indian Council of Medical Research (ICMR) state that pregnant women with heart disease are at “highest risk”.
Joy turned anxiety for mothers-to-be
Speaking to ThePrint from Chandigarh, Madhu said she found pharmacies in her state Himachal had run out of the medicines she required, particularly a hormone-based medication she was supposed to take until the fifth month.
She said she left with her husband for Chandigarh on 25 March to get her medication, but was reprimanded at most checkpoints for travelling when there was no “real” medical emergency.
The couple is now staying in Chandigarh with Madhu’s sister, and they consider themselves lucky.
“Not all pregnant women have this option to reside in another city because they didn’t get proper healthcare,” said Madhu, who prefers to be called by her first name.
Madhu’s is not an isolated case.
Several other pregnant women TherPrint spoke to complained of not getting required medicines easily.
In Karnataka, certain medications such as HCQS 2000 that are prescribed to pregnant women with auto-immune issues, is not available in the markets, it was learnt. A doctor also said regular visits to hospital could “pose a risk to the pregnant lady”.
Stakeholders have blamed logistics as one of the main problems for the situation.
Rajiv Singhal, general secretary, All India Organisation of Chemists and Druggists, said the issue wasn’t so much about shortage of medicines.
“Some states such as Punjab and Assam had issues but we have resolved them,” he said. “It’s not like the medicines aren’t available but many trucks aren’t able to reach the chemists since the drivers are scared to move out or aren’t being allowed to move out by their landlords.”
Rural India has its own share of problems on this front.
“Things have worsened because the government order to anganwadi workers to home-deliver dry ration for pregnant mothers or provide vaccination is facing problems in execution due to lack of transportation,” states a new paper by the Impact and Policy Research Institute, New Delhi.
The troubles, however, are not just limited to medicines.
Fazil Khan, a resident of Haldwani in Uttarakhand, is worried about his eight-month pregnant sister Nazia, who lives alone at Khureji Khas in Krishna Nagar, New Delhi.
Nazia told ThePrint that she needs a woman to help her out given “complications in her pregnancy”. “I am very stressed, there are bodily changes and I need someone, ideally another woman by my side,” she said. “The clinic I used to go to is also closed.”
Fazil had Sunday evening taken to Twitter to request Delhi Chief Minister Arvind Kejriwal that his family be allowed to reach her.
1/2 @ArvindKejriwal @narendramodi @PMOIndia @delhigov It’s a very Urgent request MY sister Is Pregnant and she in Delhi (area Khureji). She is All alone their and her family all of us are here in Uttarakhand Nainital..and someone from our family really need to catch up with her
— Mohammad Faizal Khan (@faizal_kkhan) April 12, 2020
When contacted, Shaleen Mitra, Advisor to Delhi Health Minister Satyender Jain, said, “An ambulance will be arranged if there is any emergency, however, we will make an announcement soon in this regard for pregnant women.”
Rajdeep Gupta, an IT engineer from Jhansi, Uttar Pradesh, is worried about his wife who is in her 35th week of pregnancy.
“I applied for a movement pass twice on the Delhi Police website, but each time it was rejected,” Gupta, who is now living in Delhi with his wife, told ThePrint.
His wife’s doctor has been in touch over the phone, but her clinic is closed.
Gupta doesn’t know yet where he will get help from when his wife delivers and after that.
Emergency helplines, virtual OPDs
Some hospitals and NGOs have taken measures to help pregnant women during the lockdown.
For example, ARMMAN, a Mumbai-based non-profit organisation, launched a pan-India free virtual OPD system this week with the help of volunteer doctors. Pregnant women and new mothers can call a toll-free number, 1-800-212-1425, to reach obstetricians and paediatricians for free virtual OPD. This comes after the overwhelming response the NGO received to a similar initiative last week in Mumbai and Aurangabad.
“Currently we have the capacity to receive 250 calls a day, each of minimum 10 minutes duration,” Dr Aprane Hegde, a uro-gynaecologist and founder of the NGO, told ThePrint.
The NGO claimed 50 obstetricians are already a part of the virtual OPD and an equal number of pediatricians are expected to join.
According to Dr Ashok Anand, head of the obstetrics and gynaecology department at the Sir J.J. Group of Hospitals (Mumbai), there has been an increase in the number of pregnant women visiting the hospital.
“Since we are a referral hospital, the pregnant women are being referred to the J.J. Hospital from the other hospitals. If they do not have any pregnancy complications which need to be monitored, we tell them to come only when they near the due date of child birth,” said Dr Anand.
Dr Ashalata Menon, consultant obstetrician and gynaecologist in Thane, said since pregnant patients are not getting real time with the doctor, many of them are showing high anxiety levels. “The hospital is giving appointments to only those who are in the 35-37 weeks of pregnancy and due for child birth. Social distancing is impractical in the labour room when a baby is being delivered.”
In Chandigarh, a private hospital said they have asked patients from other states to not come due to the travel restrictions in place but are accepting local patients. “We have also agreed to take in patients referred from other hospitals since they are busy in treatment of Covid-19 patients,” Dr Bindu Bedi, head gynaecologist at the Bedi Hospital, told ThePrint.
Mental health a cause for worry
The ICMR guidelines say it is “critically important that support for women and families is strengthened as far as possible, and that these woman are asked about mental health at every contact”.
For pregnant women suffering anxiety during the lockdown, doctors suggest daily breathing exercises, yoga and a nutritious diet.
Dr Duru Shah, who runs an infertility clinic in Mumbai and is also attached with Breach Candy Hospital, said, “It is important to keep yourself engaged. One can read up more on pregnancy, there are several webinars and YouTube videos…and several online classes. Many of these are free of cost.”
She said women should stay in touch with the doctor over the phone, and can also consider reaching out to mental health counsellors if required.
Speaking to ThePrint, another doctor said, “Pregnancy is a biological process and unless there is an extreme symptom of excessive bleeding or vomiting or discharge, women shouldn’t worry too much. Doctors are available even if it’s a lockdown.”
Cops intervene for pregnant women
Shortage of gynaecologists aside, the state police in various parts has emerged as saviour for pregnant women in the time of this pandemic.
In Jammu’s Channi Himmat area, Sonia Devi delivered her newborn in a local police van that was being used to transport her to a hospital after she made a distress call to the police helpline on 25 April.
Since the lockdown began on 25 March, PCR staffers in Delhi have admitted 211 women in labour pain at various hospitals. On 7 April, Delhi Police personnel moved 33 pregnant women, including a Finland national, to various hospitals here.
(With Haima Deshpande in Mumbai, Rohini Swamy in Bengaluru and Azaan Javaid in Srinagar)