Who is asking after maternal health during this crisis?

On June 1, Udupi resident Manjunath Kamath shared a post on social media, detailing how the health of a pregnant international traveller returning to India worsened after she was put in quarantine, due to lack of medical support. Eventually, she had to undergo a pre-term delivery.

Within hours, Kamath got several responses, with people sharing their ordeals, including one from a woman who lost her baby in the womb. "I lost my child as I could not get scanning and other check-ups done regularly," the message read.

The woman's doctor had suggested that she observe fetal movement and visit them only if there is a problem.

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When she visited the hospital as she felt the baby movement was abnormal, the hospital asked her to get the scanning done outside. For this, she had to visit four scanning centres. "I could've saved my child had I got proper guidance and immediate treatment. Aren't non-Covid-19 medical emergencies equally important?" she messaged Kamath. The woman lives in Dakshina Kannada, a place well-known for its healthcare facilities.

On July 2, a pregnant woman in Bengaluru was turned away by five hospitals in 12 hours, before she was finally admitted to the KC General Hospital.

These incidents point to how thousands of expectant mothers across the state are faced with a lack of prenatal care, coupled with the fear of the virus. With a majority of healthcare personnel pressed into Covid-19 duty, other health emergencies, including pregnancy-related complications, have taken a backseat.

The recent Health and Family Welfare Department survey in Karnataka has identified 489,907 households with pregnant or lactating women. As per the Union Health and Family Welfare Department website, 256,545 pregnant women and 212,777 newborns have been registered in Karnataka from April 1 to July 10.

Read: 'The medical community has learnt how to deal with Covid-19 over time'

While everyone agrees that the disruption was unintentional and that the administration was proactive to a large extent, gynaecologists, grassroots workers and experts feel that the government failed to foresee the situation and prepare accordingly.

Dr Sanjeev Kulkarni, a gynaecologist in Dharwad says, "Many pregnant women couldn't get health supplements regularly. The disruption of regular check-up for 2-3 months aggravated the medical condition of some pregnant women, who had mild complications otherwise. This crisis will have a long-lasting impact on them, leading to malnutrition in mother as well as baby and long-term complications in the child."

"We are also seeing a large number of women who were not prepared for pregnancy. With a lack of access to contraceptives and abortion services, their reproductive health is being compromised. Expectant mothers are visibly stressed and panicked about the uncertainty in getting access to healthcare when required. Due to the conversion of government and private hospitals into Covid care centres, women are forced to change hospitals as well as their known doctors, further increasing their anxiety. Non-availability of senior gynaecologists who may be high risk for Covid-19 is understandable, but only adds to the crisis," says Dr Shaibya Saldanha, a gynaecologist in Bengaluru.

She says that a referral system and increased communication and collaboration among doctors would go a long way in providing necessary assurance to pregnant women. She suggests that the government take up OPD triage and effective dissemination of essential information.

Also read: Non-Covid-19 patients left in the lurch as virus swamps hospitals

Dr Vijayalakshmi, an obstetrician at KC General Hospital in Bengaluru, which caters to pregnant women who test negative for Covid-19, feels that though pregnant women don't fall under the high-risk category, it is better to avoid unnecessary exposure to the virus. "There is a gradual increase in Covid-19 cases among pregnant women. We have reduced the number of check-ups. Except for high-risk cases, we suggest others to visit local healthcare centres. However, we don't wait for Covid-19 test report during emergencies including delivery," she says.

Unwanted pregnancies

Grassroots health workers have noticed a rise in unwanted conception and early pregnancies during the lockdown. A study by Ipas Development Foundation on access to abortion services in India estimates around 1.85 million abortions (47% of the estimated 3.9 million abortions that would have taken place under normal circumstances) in India to have been compromised between March 25 and June 24.

Confirming pregnancy, early pregnancy and unexpected pregnancy are some other challenges observed in the villages of Bagalkot, Gadag and Bijapur districts. Logistics, mainly transportation is a problem for many women.

Activist Brinda Adige says, "Other forms of reproductive health services such as abortion are not getting the required attention. While telemedicine emerges as an alternative, it is not convenient for a large section of women, particularly those from low-income families, to avail this."

While many do not know how to explain health problems, family atmosphere is not conducive for many others. Inadequate space inside the house only adds to the problem. The government instead, must equip hospitals to have enough people to cater to women who require reproductive healthcare, she adds.

Dr Rajkumar N, deputy director (Maternal Health), Karnataka State Health and Family Welfare Department admitted that the department didn't expect the crisis to escalate to such an alarming proportion. "Healthcare professionals and frontline workers were pressed into Covid-19 duty. As a result, around 20% of services have been affected. However, we saw to it that we didn't lose focus," he tells DH. He explains how helpline services such as Apthamitra (14410) were leveraged to reach out to pregnant women and follow-up on their health.

"We have contacted around three lakh of 10 lakh pregnant women in the state. We intend to cover all of them soon, and regularly check on them," he says.

"Pregnant women understand the need for limited exposure in this unprecedented health crisis. They only need assurance and emotional support to endure the struggle," says an Accredited Social Health Activist in Belagavi district.