Government data presented in Parliament last week in reply to a question showed that there was only a marginal disruption in institutional deliveries in government hospitals across India during the COVID-19 period in 2020-21 and 2021-22.
In response to a question by Rajya Sabha members Manoj Kumar Jha and Abir Ranjan Biswas, the Union health ministry replied on March 15 that 2,02,27,064 crore institutional deliveries had taken place in India during 2019-20.
This number came down to 1,94,43,293 in 2020-21, down nearly 4 percent, as per the details shared by the states through the Health Management Information System (HMIS), the government said.
The ministry manages the HMIS to track health information related to maternal and child health from government facilities across the country.
Between April and December 2021, on the other hand, about 1,40,77,158 institutional deliveries took place.
These figures signify that there was only a small drop in institutional deliveries across the country during the pandemic, but reproductive and child healthcare campaigners are contesting the statistics.
Unsafe deliveries, mainly carried out at home by untrained midwives, have been closely associated with increased complications for women during childbirth and higher maternal mortality rates.
‘Data doesn’t match anecdotal evidence’
Activists have been fearing that the massive disruption in maternal health services as reported from states during the COVID-19 pandemic and lockdown could have pushed India’s effort on ensuring safe deliveries back by several years.
For many of them, the latest data furnished by the government appears hard to digest.
“This is purely numbers covered and it is very difficult to make sense of it without adequate denominators,” said Dr Subhashri B of CommonHealth, a multistate coalition of organisations and individuals advocating better access to sexual and reproductive health.
By denominator, she meant the number of women who may have needed to deliver their babies in government hospitals.
The government replies show that the number of women who accessed at least four antenatal check-ups in 2019-20 was 2,30,55,973 and came down to 2,16,14,692 in the next financial year.
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Dr Jashodhara Dasgupta, co-convener, Feminist Policy Collective, said that the replies do not match the experiences of local non-governmental organisations working in rural areas, anecdotal evidence and versions of healthcare personnel such as Accredited Social Health Activists (ASHAs).
“We know for a fact that for months, women struggled to get access to health facilities due to lack of transport, and a large number of hospitals were denying services to women in labour,” she said.
“So it’s difficult to reconcile with the latest data which is showing that there was negligible disruption in institutional deliveries.”
HMIS not updated for months during COVID-19 peaks
Aligned with the goal of reducing maternal and child deaths through improved access to maternal health services, the National Rural Health Mission (NRHM) was introduced in India in 2005.
Crucial to the NRHM is ASHA tasked with the role of mobilising, counselling and supporting pregnant women, particularly in relation to institutional delivery, antenatal care and postnatal care.
Data related to these services, apart from a few others such as maternal and child immunisation as part of the country’s universal immunisation programme, are regularly updated in HMIS.
Activists however pointed out that in 2020, the HMIS data which promises near real-time information on crucial maternal and child health indicators, was not updated between March and November, a fact accepted by the ministry officials.
“That’s why we cannot be sure how the states entered the backdated data showing things were almost on track,” Dr Dasgupta said.
Dr Subhashri agreed: “Since the HMIS was not updated for several months in 2020-21, I am not sure about the credibility of data that the government is presenting now.”
Women struggling to access maternal healthcare even now
Dr Dasgupta recounted a conversation with a woman in a Delhi slum a few weeks earlier.
The woman, in her 30s, was forced to deliver her second baby under a pushcart used by her street vendor husband after a government hospital turned her away when she was in labour as she could not produce a negative RTPCR test report.
“There are innumerable instances like these as testified by local media reports and ongoing court cases to show women in labour have been turned away by hospitals as they could not immediately produce proof of being COVID-19 negative,” she said.
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These women, on several occasions, were forced to deliver on streets outside hospitals or had to rely on midwives who are poorly trained, rusty and do not often practise safe childbirth practices.
A health researcher associated with Jan Swasthya Abhiyan echoed similar views and questioned the government's reply whitewashing such instances.
What the government is depicting, she said, is in stark contrast with the situation on the ground.
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