With the debate around abortion rights raging across the United States, it’s important to turn our gaze inwards. India records an estimated 2.7 crore pregnancies every year, and accounts for nearly one-fifth of the world’s annual childbirths—2.5 crore each year (with an average of 67,000 babies a day). However, for many pregnant women in India, the prospect of giving birth is often plagued by various antenatal and postnatal issues.
The perinatal period changes a woman’s physical and mental balance and her health behaviours and lifestyle. Lifestyle during pregnancy can have enduring effects on the mother as well as the newborn’s health. For example, according to a study, 13.1 per cent of preterm babies get exposed to prenatal smoking (via maternal smoking) in India, leading to a mortality rate of 8.5 per 10,000 neonatal deaths. Further, research shows that maternal alcoholism in the first three months of pregnancy can cause the baby to have distorted facial features.
While the explicit negative effects are known to several women, unfortunately, the implicit effects remain unknown and ignored by many. Perinatal care is generally restricted to controlling personal habits such as maternal smoking, alcoholism and diet governance. However, in reality, perinatal care is much more than these. With today’s changing outlook and lifestyle including habits, hobbies, daily behaviour, and environment, women develop various complications during pregnancy and a year after giving birth. These include gestational hypertension, gestational diabetes, foetal growth retardation, big babies, miscarriage, stillbirth, preterm birth, obesity, depression, changes in appetite, sleep, and energy, vaginal changes, sagging breast, lax abdomen, varicose veins, and haemorrhoids.
Further, in many cases, lack of awareness and guidance about scientifically proven evidence-based clinical advice result in postpartum health complications that lead to ill health for both mother and the newborn. For example, women are advised to eat frequently during pregnancy, which often results in excessive weight gain, leading to comorbid conditions such as gestational hypertension and gestational diabetes. Incorrect folklore that leads to women getting advised against doing exercise during pregnancy is also an issue.
A student team guided by Max Institute of Healthcare Management (MIHM) affiliate faculty at the Indian School of Business conducted research based on secondary data to examine the current state of the pregnant woman and its associated implications in India. Some preliminary analyses revealed interesting findings.
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Intensity of the perinatal problem in India
First, more than 30 districts had a >40 per cent prevalence of obesity among pregnant and postpartum women across 37 districts of 10 Indian states, including Bihar, Delhi, Haryana, Jharkhand, Karnataka, Madhya Pradesh, Telangana and Uttar Pradesh, in 2018 -2019.
Second, hypertensive disorders of pregnancy occur in about 10 per cent of all pregnant women. Preeclampsia (a condition that develops in pregnant women, marked by high blood pressure and proteins in the urine) affects 8-10 per cent of pregnancies across the country. Other hypertensive disorders include eclampsia, gestational hypertension, and chronic hypertension. According to a study by the American College of Obstetricians and Gynaecologists, in which had 5.4 per cent of respondents were from India, the prevalence of hypertensive disorders during pregnancy was recorded as 7.8 per cent.
Third, gestational diabetes is a major public health problem in India, with a reported prevalence rate between 4.6 per cent to 14 per cent in urban and suburban areas.
Fourth, about 22 per cent of Indian mothers suffer from postpartum depression (PPD). According to the World Health Organization, ‘postpartum blues’ is a special type of depressive disorder, common in new mothers and, if left untreated, affects a woman’s ability to take care of the newborn and herself.
Fifth, significant and complex skin changes in post-pregnancy include loss of skin turgor, acne flare, hair loss, pigmentation, stretch marks, melasma/chloasma (a brownish black pigmented patch on the cheeks in 40-75 per cent of women in pregnancy) are common in more than 90 per cent of women.
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Potential solution
On the one hand, many hospitals in India do not have in-house physiotherapists or dieticians available to nurture women’s health. The doctors do not have enough time to explain the entire delivery process to the mother in detail and prepare her mentally and emotionally for the delivery. There is a lack of awareness and accessibility of the extra-medical services for perinatal women and newborns.
On the other hand, most pregnant women and new mothers get overwhelmed with taking care of the baby and pay little attention to their care. Just like how breastfeeding kits that many corporate hospitals offer, with special preventive care awareness and services for the newborns, pregnant women also need such care. Maternal awareness and comprehensive maternal health (both physical and mental) services offered to pregnant women could limit the issue to a great extent.
Maternal and extra perinatal service package with customisations—nutritional advice, physiotherapy, childbirth classes, lactational counselling, information about breast milk bank, nursing support, psychotherapy in postpartum depression conditions and aids, postpartum awareness, weight management program, postpartum cosmetology, and antenatal and postnatal yoga, birth spacing counselling—is indeed an opportunity for healthcare entrepreneurs to create value.
Certainly, the product-service mix that the offering could target creates a great value both in urban and rural markets. Breaking the maternal myths and spreading awareness and availability of such offerings creates a win-win strategy for entrepreneurs (source of revenue) and beneficiaries (safeguarding maternal and newborn health). Potentially, the perinatal complications could be addressed and help reduce neonatal mortality and postpartum health. After all, there are millions of lives and futures at stake.
Vijaya Sunder M is an Assistant Professor at the Indian School of Business (ISB), BAT research fellow, and an affiliate faculty at the Max Institute of Healthcare Management (MIHM) at ISB.
Shilpa Veerapaneni, Fateen Fatima Mazher, Raghavendra Kumar Gudla, and Niranjana Raj are practising doctors and management students of the Advanced Management Programme for Healthcare (AMPH) 2022 at MIHM, ISB.
Views are personal.
(Edited by Srinjoy Dey)