SHILLONG: Contesting the statement of Dr Aman War, DHS, on the strikingly high rate of infant and maternal mortality (61 pregnant women and 877 newborns have died in Meghalaya in the four months starting from April for want of admission to hospitals and also due to lack of medical attention because of diversion of the health machinery to fight COVID-19 pandemic), the Department of Health and Family Welfare said several steps have been taken to address the challenges that came with the pandemic while also ensuring that essential health services continued.
Commissioner and Secretary, Health, Sampath Kumar said the weekly MCH review meetings have revealed that despite being a matrilineal society, women in Meghalaya face barriers in terms of making the right choices insofar as reproductive rights are concerned. These social barriers need to be addressed.
Explaining the conundrum, Sampath Kumar said, “Meghalaya is one of the few states in the country which did not lose focus of the basic health indicators and this is evident from the fact that despite the COVID-19 pandemic, the state has been able to rank 2nd in the country with 90 per cent immunisation coverage.”
He said Meghalaya had launched MOTHER programme in August 2019 to improve maternal and child health indicators of the state in addition to COVID-19 management. “From May 2020, a system of weekly review meetings (through video conference) on maternal and child health (MCH) issues are being taken up by the Health department every Monday with all Deputy Commissioners, District Medical and Health Officers,District Maternal and Child Health Officers,” Kumar said adding that they are being sensitised to remove the fear of COVID-19 and educate and encourage the communities and pregnant women on the importance of institutional deliveries and full immunisation to reduce mortality.
Kumar also stated that due to these focused efforts, even during the pandemic and lockdown, the state kept the Institutional Delivery percentage to the same as before the lockdown. This has been achieved while the state had continued to remain with the least number of COVID-19 infections per million population in the country.
A data comparison for April to July, 2019, was done against the same period this year, and it was found that the number of maternal and infant deaths is comparatively the same. The reporting has also increased during this period because of close monitoring at state-level and the introduction of MOTHER app to track every delivery.
What is interesting is Sampath Kumar’s observation that lack of institutional delivery and medical attention are not the only reasons for high maternal and infant deaths but more important the socio-cultural issues impinge on women and child health. Kumar said the findings were that women approach health centres with multiple pregnancies without adequate birth spacing, teenage pregnancies and women with severe anaemia which form part of the public health issues.
Clinical management and public health action are to be supported by addressing socio-cultural issues that contribute directly to the high maternal and infant deaths. These include non- acceptance of birth spacing measures (use of contraceptives) among members of society, practice of early marriage among various sections of people, which directly contribute to teenage pregnancy and hence, dependency of people on untrained birth attendants despite awareness by ASHAs and ANMs, lack of diet diversity which causes women to become anaemic in the long run amongst other socio-cultural issues.
Health department has identified action plans to approach this issue from all three dimensions, namely clinical management, public health action and socio cultural dimension. Currently the Health department is undertaking weekly MCH review meetings, rigorous sensitisation exercises with active participation from grass root healthcare workers on the need to identify high-risk pregnant women and to bring them to health centres even before their expected date of delivery.
The weekly MCH review meetings have revealed that despite being a matrilineal society, women in Meghalaya face barriers in terms of making the right choices insofar as reproductive rights are concerned. These social barriers need to be addressed.
The state team is making field visits to public health centres in all districts to bring about a convergence approach in addressing the issue. The departments of Health, Social Welfare and Education will work in tandem to address issues of teenage pregnancies by providing proper sex education to students through training of teachers and counsellors on how to give out the right messaging to students.
The Department is also forging convergence with the Integrated Child Development Services of the Social Welfare Department through the Poshan Abhiyaan Programme to focus on the nutritional aspect of this issue. There will be complete convergence of ASHAs and Anganwadis so that they complement each others’ services while delivering the much-needed sensitisation on this issue in rural areas.
The Department of Health & Family Welfare reiterates that lack of proper clinical management is only a small part of the systemic issues contributing to maternal and child deaths in the state. The public health and socio-cultural dimensions remains to be addressed and they contribute greatly towards the high mortality rate of mothers and children.
The statement made by the DHS reveals a clear misinterpretation of data. “To conclude that the high maternal and child death rate in the state is due to lack of clinical management is not a correct analysis and brings out only a partial understanding of the multiple reasons that government is fully aware of and addressing diligently at source while encouraging conversations and discussion around the same among various stakeholders,” Sampath Kumar stated.