Priyanka Das, Mission Director, National Health Mission, Government of Madhya Pradesh highlights Madhya Pradesh government’s efforts to scale up COVID-19 vaccination for pregnant women
Amidst widespread hesitancy, misinformation, and mistrust on several facets of the COVID-19 vaccination drive, Madhya Pradesh initiated the vaccination of pregnant women on 23rd July 2021, following NTAGI’s recommendation that pregnant women should be included in COVID-19 vaccination (National Technical Advisory Group on Immunisation in India presentation shared with the states) campaign. Before the launch, the honourable Chief Minister, Shivraj Singh Chauhan urged all sections of society to avail COVID-19 vaccination services for pregnant women with the same enthusiasm as they have done during the COVID-19 vaccination drive for the adult population. He encouraged citizens to come forward to participate in this critical campaign to save the lives of not only pregnant women but also their children.
By October 2021, Madhya Pradesh became the state with the highest vaccination for pregnant women. As of 16th Nov, the state has administered the first dose of the COVID-19 vaccine to more than 3.30 lakh pregnant women which accounts for approximately 24 percent of the total pregnant women vaccinated across the country. This feat has been achieved due to a series of targeted interventions, which were part of Madhya Pradesh’s Jan Bhaagidari approach and outreach model. The first step taken was to address critical questions about the safety and efficacy of vaccines and disseminate this information in an simple, effective, and comprehensive manner as possible. Communication plans were devised and implemented through a series of visually appealing information, education, and communication collaterals.
It has often been observed that the decision to vaccinate is not taken by the woman alone. The couple and in most cases, the entire family, is involved in the decision-making process. Hence, national guidelines for the vaccination of pregnant women were widely circulated as part of a mass education campaign, through various social media platforms. Auxiliary Nurse Midwives (ANMs), Staff Nurses and Accredited Social Health Activists (ASHAs) were trained in counselling and communicating the risks of COVID-19 on the health and pregnancy outcomes, benefits associated with the COVID-19 vaccine as well as potential side effects and rare complications associated with vaccines. Antenatal check-ups that involve visits by expecting mothers to the health facility, outreach immunization sessions, Village/Urban Health, Sanitation and Nutrition Days (VHSNDs and UHSNDs) and COVID-19 vaccination centres are set up as the primary touchpoints to communicate vaccination-related messages to the beneficiaries. Further, at the village level, ASHAs conduct household visits to inform and counsel the family on the safety of vaccines for pregnant and lactating women. To supplement the work of ANMs and ASHAs, dedicated staff have been made available to counsel mothers and answer any questions they may have.
Initially, access to COVID-19 vaccines for pregnant women in Madhya Pradesh was limited to District Hospitals, when introduced in July 2021. However, since Sub-Health Centres (SHCs) are the first point of contact for primary care, especially in rural areas, the supply of vaccines was extended to these facilities as well. Steps have been further taken to vaccinate pregnant women in VHSND sessions, via mobile sessions and house-to-house vaccination, wherever needed. Special vaccination drives are conducted for pregnant and lactating women. The aim is to ensure that no one is left behind and everyone has access to life-saving vaccines.
The fear of Adverse Events Following Immunization (AEFIs) is often a major cause for vaccine hesitancy. To allay the associated fears, beneficiaries are monitored for 28 days post the first dose to identify side effects of the vaccine, if any. The Surakshit Matritva Ashwasan (SUMAN) tele-calling system, which provides counselling for various maternal and child health services, is leveraged to track pregnant women after vaccination. Partnerships are forged with leading medical bodies such as the Federation of Obstetric and Gynaecological Societies of India, Indian Association of Paediatrics, Indian Medical Association, and locals NGOs to reduce information gaps, spread awareness and generate demand.
Systems have also been set up to enable closer coordination between different government ministries. Anganwadi Workers, from the Ministry of Women and Child Development, are encouraged to mobilize lactating women for COVID-19 vaccination; while ASHAs from the Ministry of Health and Family Welfare, is tasked with mobilising expecting mothers. A large network of Self-Help Groups (SHGs) under the National Rural Livelihood Mission (NRLM) is also utilised to build confidence among community members and motivate beneficiaries to avail of the vaccination services.
For targeted efforts towards beneficiary tracking, existing databases have been extensively leveraged. The ANM Online (ANMOL) portal, developed for the early identification and tracking of Eligible Couples, Pregnant Women and Children, is leveraged to identify pregnant and lactating women and mobilize them for COVID-19 vaccination. The line-lists of pregnant and lactating women generated from ANMOL are shared with a group of mobilizers such as ASHAs, Anganwadi Workers (AWWs) and Self-Help Group members to inform beneficiaries about their due dose and the importance of full vaccination. At the state level, district-wise performance on pregnant women vaccination is closely tracked and reviewed.
At the facility level, lactating mothers, who bring their children for routine immunization at regular intervals, are also being provided COVID-19 vaccines. Special arrangements are being made for post-delivery vaccination and initiatives like the Teeka Trolly have been launched to enable vaccination in Out Patient Department (OPD) and hospital wards.
As a result of focused efforts to reach out to pregnant and lactating women, Madhya Pradesh has been able to bridge equity gaps, especially on gender, in its COVID-19 vaccination campaign. It is in the protection of our most vulnerable that we will ultimately show our true strength. By fast-tracking access and monitoring for COVID-19 vaccines for lactating and pregnant women via expanding vaccine platforms, session site locations, duelists from allied programs and dedicated counselling and post-vaccination follow-up processes, Madhya Pradesh aims to provide the protection owed to all the mothers and children.