The information released by Meghalaya’s Director of Health Services (DHS) that at least 61 pregnant women and 877 newborns have died in Meghalaya from April to July this year due to diversion of resources toward battling the coronavirus, has shocked the country. The DHS said these fatalities were on account of reasons other than Covid19. The death of newborns was mainly due to lack of medical attention, care, pneumonia and birth asphyxia. This has happened primarily because most women choose to deliver at home.
The state has an infant mortality rate of 34 deaths per 1000 live births which is a big improvement from 66 infant deaths in 2002. The prime focus of the Millennium Development Goals (MDGs) was to reduce infant and maternal mortality. This goal was supposed to have been reached in 2015 but the goalposts have now been further shifted.
For those who know Meghalaya the statistics given out by the DHS are not surprising. The Journal of Primary Medicine and Family Care (Jan-Feb 2018) which conducted a study on maternal mortality in Meghalaya found that most women in the study area opted for home delivery by traditional birth attendants (TBAs), on whose skills the community had strong faith. The reasons for avoiding institutional delivery are many but the most important constraint is that of finance. The fear of out-of-pocket expenditure, ignorance of available schemes, unavailability of transport, bad roads, and distant hospitals were the important reasons why women prefer to give birth at home. Also home delivery apparently offered the women privacy and the opportunity to attend to their household chores. The perceived need for institutional delivery was low. The most common cause of maternal deaths according to auxiliary nursing midwives (ANM) is postpartum hemorrhage, which becomes hard to manage in home deliveries. By the time the mother is brought to the health facility it is often too late.
Covid 19 has exposed the abysmal health care system in Meghalaya. In fact Covid has exacerbated the difficulties faced by pregnant women wanting to access institutional delivery. The restrictions on movement and ASHA workers having been pulled away from their primary duty of attending to women in the pre and ante-natal period has only compounded the problems. In village after village women have confided that they prefer to deliver at home. News of pregnant women not being admitted to government hospitals and delivering still born babies has increased the sense of fear.
While the DHS said that most women died because they were not admitted to hospitals or health centres for institutional delivery studies have revealed that there was no facility for delivery in most Sub-centres (SCs) and often the CHCs did not have facilities for blood transfusion. There is also a shortage of basic equipment such as Ultrasound machine. Clearly the investments in healthcare have been sorely inadequate and the gender dimension here cannot be missed.
