How the pandemic has led to a steady decline in institutional deliveries and access to maternal healthcare
Poonam Muttreja, Executive Director, Population Foundation of India shares the how the COVID-19 pandemic has posed challenges for the poor, vulnerable leading to critical health services being severely disrupted, some states have taken measures to address this but we need to strengthen existing public health systems, infrastructure, service delivery mechanisms to meet challenges posed by the virus without neglecting routine maternal, child healthcare services
The COVID-19 pandemic has globally affected the lives of people in many unexpected ways. As healthcare systems struggle to ensure emergency services to curb COVID-19 transmission and provide medical care to those affected by the disease, lockdown restrictions have had a devastating impact on the lives and livelihoods of the marginalised and the underprivileged.
The challenges for the poor and vulnerable are innumerable. Some have received the attention they deserve. Others have not. Neglected to a very large extent has been the plight of pregnant women seeking maternal care and medical attention.
In April, barely a month into the country-wide lockdown, a 22-year-old Muslim woman from Bihar’s Buxar district was reportedly denied treatment for complications that had developed in the later stage of her pregnancy. The woman and her mother were repeatedly turned away by the primary health centre and district hospital as she belonged to a community that was being stigmatised and blamed for the spread of the disease. Both her husband and father were migrant labourers in Hyderabad and were unable to return to Bihar due to the travel restrictions imposed by the lockdown. The woman later delivered a still born child in a private hospital nearly 30 kilometres away from where she lived and is reported to be facing mental health issues after the incident.
In June, a 30 year-old pregnant woman died in an ambulance after she failed to get medical attention. She had complained of breathlessness due to low blood pressure but was turned away by eight hospitals over a span of 13 hours that cited lack of beds and being burdened by COVID emergencies. And this was a case in Noida, a bustling city in the National Capital Region.
The pandemic and lockdown restrictions have intensified prevalent socio-economic inequities, rendering women from the marginalised sections more vulnerable in these unusual circumstances. We have witnessed and read many heart-wrenching reports over the past few months about homeless women giving birth on the streets due to the inability to get beds in municipal hospitals. There have also been instances of migrant women delivering children during their arduous walk back home and even continuing to walk after that.
Critical health services have been severely disrupted as a result of containment response systems in place. These include immunisation schemes, nutrition-related interventions, institutional deliveries as well as ante-natal care that are pertinent to the well-being of pregnant women and newborn children. Women, particularly those in later stages of their pregnancies, are faced with the inability to visit gynaecologists for ante-natal check-ups due to travel restrictions. Given that a large number of deliveries happen in small private nursing homes, their closure has also contributed to the decline of institutional deliveries.
While Government of India’s Ministry of Health and Family Welfare has mandated the provision of all essential maternal health services during the lockdown, most states have prioritised the emergency response to COVID-19 over other essential health services. They continue to do so, even as the lockdown has been lifted. Besides, stigma and lack of adequate information regarding the spread and treatment of the disease have only amplified the difficulties that women from vulnerable communities have to face.
Recent studies have forewarned us against the long term consequences of the neglect of maternal and child health services. For instance, a study by Guttmacher Institute has projected that in low and middle income countries, a 10 per cent decline in service coverage of essential pregnancy- related and newborn care will lead to 1,745,000 additional women experiencing major obstetric complications without care and 28,000 additional maternal deaths. 
Data from the Health Management Information System on institutional deliveries are not available in the public domain. However, media reports suggest a somewhat sharp decline in institutional deliveries in several states such as Uttar Pradesh, Bihar, West Bengal, Jharkhand, Odisha and Chhattisgarh during the lockdown.
These figures are alarming and if such conditions continue to persist, they could potentially increase maternal and infant mortality. This will prove to be a setback to the considerable progress that India has made in reducing the maternal mortality ratio (MMR) by 77 per cent between 1990 and 2016.  Slippages might also be seen in the proportion of institutional deliveries in public facilities that had almost tripled from 18 per cent in 2005 to 52 per cent in 2016. Denying pregnant women timely care and treatment will only make matters worse and set India back on achieving its global development targets.
Pregnant women today are battling anxiety. They are living with the fear of coming in contact with COVID-19 patients, which is fuelled by conflicting views around disease transmission from mother to the child. Medical service providers too, have been facing challenges trying to streamline deliveries and consultations in the wake of the COVID-19 pandemic.
Some states have taken measures to safeguard the health and interests of pregnant women paving the way for possible solutions for others to follow. The Jammu & Kashmir administration as well as the state government of Chhattisgarh have recently decided to set up separate hospitals for COVID-19 infected pregnant women. They have made arrangements for women to give birth to their babies in these hospitals even as they are undergoing COVID-19 treatment. There have also been reports of Police Control Room mobile patrol vans in Delhi stepping up efforts to provide emergency hospitalisation services for over 700 pregnant woman during the lockdown.
While these are welcome steps, much more needs to be done to safeguard pregnant women, particularly those in the rural areas where infrastructural inadequacies have been a challenge even before the COVID outbreak.
As cautioned by healthcare experts globally, COVID-19 is here to stay and is likely to persist as an endemic disease. The need of the hour, therefore, is to strengthen existing public health systems, infrastructure and service delivery mechanisms to meet the challenges posed by the virus without disrupting routine maternal and child healthcare services.