Resilient healthcare systems are key to ensuring maternal health
India is the 2nd most populous country in the world today, accounting for 16% of the global population. The mortality rate is growing at an average of 2.28% every year with a maternal mortality rate of 113 per 1 lakh live births. Malnutrition, infectious diseases, unregulated fertility along with female feticide, infanticide, lack of awareness, and the inadequate availability and use of Maternal Child Health (MCH) services contribute to the mortality rate.
The COVID-19 pandemic has not only affected routine health services but significantly disrupted maternal and child health services as well. Fear of contracting the infection hindered women seeking care and accessing a facility along with acquiring appropriate treatment. This may have contributed to an increase in maternal mortality when compared to the pre-pandemic era. Furthermore, with healthcare workers being shifted to the COVID-19 duties, limited coverage and the shortage of workers in primary healthcare facilities further compounded these challenges.
Challenges to Indian healthcare systems for maternal and child safety
While India fares significantly better than the global average of 43% in reduction of maternal mortality, mortality due to pregnancy and childbirth-related causes remains significantly high. Strong public health policy and legal framework, laws, regulations, policies, and strategies on the quality of care do exist in the country, however, they are largely fragmented.
The lowest levels of antenatal care have been observed in South Asia, and only 51% of Indian mothers received sufficient care post-pregnancy. Furthermore, lack of appropriate care during pregnancy and childbirth and inadequate services for identifying and managing complications pose additional challenges. Studies show that 18% illiterate women opted for institutional deliveries as compared to 86% women who had at least 12 years of education. Institutional delivery is one pertinent intervention which is proven to reduce maternal mortality through creating a safe delivery environment. While the Government has taken cognizance of the importance of encouraging institutional births and antenatal care, all stakeholders must come together to heighten the awareness to further increase the uptake.
The COVID-19 Dimension
Vulnerable populations like expecting mothers and newborn infants have been detrimentally affected due to COVID-19. All the existing maternal and childcare-based problems have been exacerbated due to the overburdened healthcare infrastructure. These disruptions have resulted in significant collateral damage not only for the reproductive and perinatal health but also indirectly because of changes in healthcare, social policy, or social and economic circumstances
Alongside these, guidelines for labor, delivery, and breastfeeding for COVID-19 positive patients varied creating fear and uncertainty. New mothers and infants were greeted by the harsh realities of the COVID-19 imposed lockdowns and curfews, followed by overwhelmed healthcare systems, and a shortage of sufficient skilled birth attendants. Uncertainty regarding guidelines and vaccinations further compounded these challenges.
Resilient healthcare system is key to better maternal and infant health
Sustainable and resilient healthcare infrastructure is crucial to ensuring continued care in face of the current and any future pandemics. The risk of mortality and pregnancy-related complications can only be mitigated by increasing access to quality preconception (before pregnancy), prenatal (during pregnancy), and interconception (between pregnancies) care. While the government has initiated several flagship programs to provide neo- and antenatal care, free of cost to expectant mothers and infants, there is a need to build public trust in institutional deliveries and maternity health infrastructure. True resilience can be built by communities and young mothers working together to join hands with the healthcare community and build structural pathways to manage such sudden and devastating disruptions as was caused by the pandemic.
Antenatal care is essential for protecting the health of Indian mothers and their children. Through this form of preventive health care and skilled health personnel, women can have better access to knowledge on healthy behaviours during pregnancy such as understanding warning signs during pregnancy and childbirth. They can also receive social, emotional, and psychological support at this critical time in their lives.
There is an urgent need to strengthen healthcare system for Indian women and children which can only be possible via collaborative and cohesive action among the hospitals, healthcare workers, the pharma ecosystem, civil society and the Government.
