A report published by The Lancet in September 2020 suggested that the second wave of COVID-19 in the UK affected pregnant women more intensely, though the exact reason for this was unclear.
As India experiences its most threatening second wave, doctors are anecdotally claiming that the new variants of the coronavirus have been more aggressive in pregnant women, with a sharp rise in postpartum death. Research by the National Institute of Health Studies also suggests that pregnant COVID-19 patients with severe symptoms were at a higher risk for cesarean delivery, postpartum haemorrhage, hypertensive disorders of pregnancy, and preterm birth.
Ravish Chawla, a Delhi resident, who lost his wife and unborn child to COVID-19, shared a video on Twitter of his wife, in her last days urging people not to take the infection lightly. It was this video that that brought the plight of pregnant COVID-19 patients into mainstream discussion.
Problems faced by pregnant women
- Higher risk of developing severe COVID-19
Pregnant women, specifically those who are older, overweight, or have preexisting conditions like diabetes or hypertension are at a higher risk of developing severe COVID-19. The WHO Guidelines state that pregnant women who develop severe disease, seem to more often require care in intensive care units compared to non-pregnant women of reproductive age. Due to the changes taking place in their bodies and immune systems, they can be badly affected by respiratory infections.
- Less frequent prenatal checkups due to the high risk of infections in hospitals
A clinical article published in October of 2020 in the International Journal of Gynaecology and Obstetrics states that ‘One‐third of women had inadequate antenatal visits. The main reason for delayed health‐seeking was lockdown and fear of contracting infection, resulting in 44.7% of pregnancies with complications.’ Infrequent prenatal checkups could lead to complications later in the pregnancy which puts pregnant women and their children further at risk.
- Resistance to CT scans
Women who contract the virus and develop COVID-19 pneumonia would require CT scans to effectively monitor their conditions. This increases radiation exposure to them and their unborn child. Though reports state imaging of areas other than the abdomen and pelvis do not put the baby at risk, women still feel hesitant to undergo CT scans, due to the risk of a possible miscarriage. Ravish Chawla recalled how his wife did not want to undergo a CT scan, since she felt it might put her unborn child at risk.
- Unclear data on mother-to-child transfer
While some reports suggest that vertical mother-to-child transmission of the coronavirus is not possible, other studies suggest that it is. In a sea of unclear data, pregnant women are left confused, not sure what to believe or what actions to take. Further, the information on the steps to take post-delivery varies from sources. The WHO recommends that infants and mothers with suspected or confirmed COVID-19 “should be enabled to remain together and practice skin-to-skin contact.”
On the other hand, The United States Centre for Disease Control and Prevention (CDC) advises that facilities “consider temporarily separating the mother from her infant” until the mother is no longer considered contagious.
- Systematic and Historic Inaccessibility of Medical Services for Women
Historically, due to structural constraints, and their weaker economic and social status, healthcare is comparatively inaccessible for women. Cultural norms associated with women’s general and sexual health make it so, that women in India are less likely to seek medical help or go to the hospital when sick, compared to their male counterparts. In Punjab and Haryana, more boys below 5 are admitted to hospitals than girls, this is not because girls do not fall ill, rather because when they do, it is not a priority to get them admitted. This divide is even greater in rural areas of the country, which have been hit extremely hard in the second wave. Here it is important to note that 65% of the population in India, resides in rural areas.
What are the Government’s guidelines?
While the ICMR has published guidelines for the management of pregnant women in the COVID-19 pandemic, the overcrowding of hospitals, even in urban areas, makes these difficult to follow. It took two days for Noida resident Utsav Kumar to find a hospital bed for his pregnant and COVID-19 positive wife. He stated that she was earlier admitted at Shardha Hospital in greater Noida but was removed from there because the staff was overworked and could not take appropriate care of her. Doctors too report of overcrowding in hospitals, officials at Shardha Hospital state that “The hospital currently has only 215 beds but there are 280 patients that we have to attend to.”
What about vaccinating pregnant women?
As of May 13th, 2021, The Ministry of Health and Family Welfare has recommended against pregnant and lactating women getting vaccinated. This is because there is not enough clinical data on pregnant women about Covaxin and Covishield, the vaccines offered in India.
But doctors and FOGSI chairperson, Dr. Alpesh Gandhi, state that pregnant women should be administered the vaccine, as the benefits outweigh the theoretical risks. However, Dr. Nozer Sheriar, a practicing Obstetrician & Gynocologist and former secretary-general of FOGSI stated that “the FOGSI guidelines also state that individual practitioners cannot advise vaccination to pregnant and lactating women in India, until there is a change in recommendations by the Ministry of Health and Family Welfare, Government of India.”
Further, The National Technical Advisory Group on Immunisation (NTAGI) too suggested that pregnant and lactating women be given the vaccine. These recommendations will be sent to the National Expert Group on Vaccine Administration (NEGVA) for approval before they are implemented. In the USA, 90,000 pregnant women have been administered the Pfizer and Moderna vaccine, with no safety concerns. These vaccines however are not offered in India yet.
Thus, pregnant women are rendered doubly vulnerable in the pandemic. Not only are they higher-risk patients, they are also unable to access the appropriate vaccines and healthcare facilities. Despite the availability of informational protocols for pregnant women, the overcrowding of the public health system makes it difficult to implement these.
Historical and social factors also restrict the likelihood of women seeking medical help, in spite of ill health. These influence prenatal and postnatal care, putting the mother and child at an increased risk in the pandemic.
Featured Image Source: PTI