The coronavirus pandemic has caused massive disruption across the globe. As health systems across the country geared up to respond to the pandemic, they inadvertently did so at the expense of other critical public health services. Several reports point out that the number of institutional deliveries has fallen during the lockdown. Covid-19 had also reduced access to contraception and abortion services, which is likely to lead to an increase in unwanted pregnancies and unsafe abortions.
Dr Manjiri Kaba, Consultant Obstetrician, and Gynaecologist, Masina Hospital, told The Sunday Guardian: “Due to the overwhelming surge of Covid patients, many pregnant women were turned away due to lack of staff and infrastructure. These women had to resort to smaller nursing homes and government or municipal teaching hospitals to deliver their babies. Needless to say, the childbirth rate in hospitals has dropped by almost 50%. In fact, in the initial few months, there were no deliveries. Being petrified of the virus itself, a lot of ladies preferred to deliver their children at home, either unsupervised or with the help of untrained dais, jeopardizing their own health as well as the health and safety of their child.”
Dr Kaba also said that there were many women who came back with complications of poorly managed labour like perineal tears, excessive bleeding, anaemia, wound infections, and sepsis. On the other hand, newborns couldn’t get proper neonatal care and even missed out on their immunizations.
Dr Rajesh Khanna, Deputy Director-Health & Nutrition, Save the Children, told The Sunday Guardian: “Comparison of HMIS data (of quarter April-June 2019 and 2020) shows 20% decrease in reporting of Childbirths in 2020 compared to 2019. Data from June 2020 onwards is not available in the public domain. The HMIS data shows a decrease in hospital childbirths/deliveries, and these could be due to 1. disruption in delivery services due to the lockdown, and 2. decreased reporting even if they were happening.”
However, Dr Khanna also said that there is a decline in homebirths as well. “One would assume that if institutional/hospital deliveries are declining, then this should translate to an increase in the number of home births. However, as per HMIS report, home births reported during April-June 2020 period also show a decline compared to the same period in 2019 with 24% lesser births attended by Skilled Birth Attendants (SBAs) at home and 18% lesser births attended by Non-SBAs at home. Moreover, cases of pregnant women with Obstetric Complications attended to also show a decline of 19%. This suggests that apart from disruption of services, recording and reporting of data was adversely impacted,” Dr Khanna said.
In March last year, institutional deliveries dropped by 43% compared to March 2019. The number of childbirths registered in hospitals across India stood at 17,17,500 in March last year, while this year the number dropped to 9,71,782. Several health experts said that as many essential healthcare services had been hit during the Covid-19 outbreak and pregnant women are among the worst hit.
In Mumbai, institutional deliveries dropped by almost 18% between March and November 2020 compared to the same period in 2019. The number of childbirths registered in public and private hospitals between March and November 2019 stood at 111,411. During the same period in 2020, this dropped to 91,618; the lowest institutional child deliveries in March and April, as per reports.
Dr Sheela Gaur, Gynaecologist & Obstetrician, Miracles Mediclinic & Apollo Cradle Hospital, Gurugram, told The Sunday Guardian: “Most of the patients preferred giving birth in the hospitals in their hometown as traveling was difficult due to lockdown. Also, people were afraid to come to larger cities like Delhi-NCR due to the fear of infection. Pregnant women who tested positive before delivery were anxious if their child will be born with it and they have to adjust themselves to the new normal of a mask, hand hygiene, and social distancing. Since the rate of pregnancy during Covid-19 is the same as non-pandemic time, this will also mean that the healthcare providers in tier II or III cities or rural areas may have received increased footfall.”
“There are reports of rising cases of natural pregnancies during the lockdown. We cannot say if there was an increase in the number of home births. However, given that the rural healthcare centers were stressed during the pandemic, it cannot be ruled out,” Dr Gaur said.