COVID-19: Fragility of Health Governance and Women’s Health in UP
By Shadab Alam
Pre-COVID-19, Indian policymakers claimed that Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), popularly known as, Ayushman Bharat Yojana, has enabled the Indian health system to deal with any kind of health crisis. The government advertised it as one of the strongest and most efficient health policies across all third world countries. It mentioned that the scheme would provide access to health services to the poor and marginalized sections of the society. However, during the COVID-19 lockdown, most of the healthcare centres like PHCs (Primary Healthcare Centres), CHCs (Community Health Centres) and Health and Wellness Centres (HWCs) in Uttar Pradesh stopped providing basic health services, and also suspended the sexual, health, reproductive and VHND (Village Health and Nutrition Day) services, affecting women’s health egregiously.
Anaemia and women’s health
Anaemia is widespread in India. As per the National Family Health Survey (NFHS), 53.2% of non-pregnant women and 50.4% of pregnant women were found to be anaemic in 2016. The reason behind this phenomenon is gender-based nutritional discrimination; a belief that boys are the torchbearer of the family and clan, though the reality may be different. Evidently, anaemia is associated with high-risk health issues and it affects women’s sexual and reproductive health, considerably. Pregnant women need to take anti-anaemia supplements and nutrition which are distributed by the frontline health workers.
Supplements play a pivotal role in reducing the risks and complications during pregnancy. However, since most of the frontline workers were busy in testing and other tasks related to the coronavirus pandemic, they could not distribute the supplements to pregnant and non-pregnant, anaemic women. The important questions are, what will be the consequences of not taking the supplements for women who were in a dire need of those? Who is responsible for the harm caused to them? Unfortunately, there are neither answers to this nor can any grievance redressal mechanism reverse the effects these may have caused. IndiaSpend reported that 20 percent of maternal death in India is caused due to anaemia. And assuming that a considerable number of women must have been deprived of the anti-anaemia supplements during the lockdown, this definitely will put more women in life-threatening situations.
Unavailability of contraceptives and women’s health
Similarly, the suspension of the contraceptive services put women in grave health risk. There are numerous cases where women do not want more children but due to the unavailability of contraceptives, they conceive. Disregarding medical guidelines, they opt for abortions, many after every three months. Gynaecologists warn that frequent abortions are associated with grave health consequences; affecting women’s overall health adversely. There are cases where women who conceived have continued with the ‘unwanted pregnancy’ despite the doctor warning them of life-threatening risks. These women admitted that they did not have access to any modern contraceptive either at the local health facilities or from ASHAs (Accredited Social Health Activist) during the lockdown.
Besides, during the lockdown, we have recorded zero VHND (Village Health and Nutrition Day) services, which provide food and nutrition to pregnant and lactating women to fight against anaemia and vitamin deficiency. In addition, this service also provides Antenatal Care (ANC) and Postnatal Care (PNC). Additionally, it is during the VHND process, that ASHA workers identify high-risk pregnancy (HRP) and take necessary measures. But unfortunately, the government could not provide these services to millions of women during the lockdown.
Lockdown pushed the unmet need up
In an Economic and Political Weekly article, Purushottam M Kulkarni of Jawaharlal Nehru University suggests that there is a significant unmet need for contraception in India. Kulkarni highlights that about 13 percent of couples fell under this category but did not receive the contraceptive services they desired.
During the lockdown, the unmet need must have multiplied considerably. Very recently, UNFPA (United Nations Population Fund) concluded that the pandemic could cause around 7 million unintended pregnancies and leave 47 million women unable to access modern contraceptives. Since India is the world’s second-largest population, comprising 48 percent of the female population over the globe, therefore, India inevitably must have become an epicentre of unwanted pregnancies.
Institutional deliveries during the lockdown
Data from states such as Uttar Pradesh, Bihar, West Bengal, Jharkhand, Odisha and Chhattisgarh shows that the number of institutional deliveries may have fallen by as much as 40 percent during the lockdown. This phenomenon can be attributed to: first, pregnant women did not approach the nearby health facilities due to the fear of the coronavirus infection and, second, women may have approached the health facilities, but they were turned away due to the unavailability of doctors and trained nurses who were all pulled in to attend to the COVID-10 cases. Our own experience on ground validates the later. We categorically found that in most instances pregnant women have had to deliver at home due to the lack of doctors and nurses and other necessary maternal health facilities at the health centres.
As we know, homes deliveries are associated with multiple maternal health risks. A study by the World Health Organization (WHO) mentioned that nearly five women die every hour due to childbirth. In addition, WHO says, in India, around 45000 women die due to childbirth every year in the institutional delivery system. Now, imagine the number of casualties without the institutional delivery mechanism! Unfortunately, we do not have clear data on the actual deaths of women during home deliveries in India. Though, public health experts believe that the rate of causalities is very alarming.
It is clear that the government put aside women’s health and reproductive rights while taking steps to manage the pandemic situation, putting a large population of women at high risk. The lack of planning was compounded by a lack of human resources and infrastructure – India has the lowest doctor population ratio amongst the major developing economies. We were not prepared to handle this type of health emergency. And despite having healthcare schemes like Ayushman Bharat, we failed to provide basic maternal healthcare and other facilities during the pandemic. We could not stand strongly either to face the pandemic systematically or tackle maternal health issues efficiently.
Conclusion
It is time for us to re-visit our previous claims about health governance in India. The lockdown was an opportunity for us to critically examine the public health services and fix the loopholes efficiently. Going forward, the government must collect intersectional data and information about basic healthcare and maternal healthcare services and analyse the data thoroughly to provide a tangible solution for better and efficient health governance. A few other observations which could be made about the inefficiency of the health governance are lack of human resource and health budget. The government needs to increase the total health budget from 1 percent to 4 percent in order to mobilize resources for better health governance.
AUTHOR
Shadab Alam did his masters in Development and Public Policy from Azim Premji University and has been working in the development sector for five years. Currently, he is Senior Program Associate with Sahayog, a Lucknow-based grassroots-level organization, which works in the domain of public health and women empowerment.
Disclaimer: The views and opinions expressed in this article are those of the author/s and do not necessarily reflect the official policy or position of Azim Premji University or Foundation.
