This article was originally published by Global Health NOW.
By: Aliya Bashir
ANANTNAG, KASHMIR—Ruqiya Javed received treatment at a private clinic throughout her pregnancy—but when she went into labor, her private doctor refused to see her, because she came from a red COVID-19 containment zone in the Kharpora Larnoo village in South Kashmir. The family banged on the doctor’s door for hours, but no one came out to see her.
Javed was ultimately taken to the district’s Maternity and Child Care hospital, where she delivered stillborn twin sons in May 2020.
At the hospital, her husband, Javed Ahmed Padroo, says that as soon as hospital workers learned that they came from the red zone, they kept her alone in a room with a female family member, leaving her unattended for hours. “My wife couldn’t take the stress. She was gasping for breath and could hardly speak,” says Padroo.
She died hours after her delivery, 35 years old and survived by 2 young daughters.
“The hospital authorities treated us as untouchables,” says Padroo.
Currently, the situation has improved, thanks to vaccines. People are much more aware, prepared and able to handle COVID-19 now, compared to the early days of the pandemic. But Kashmir’s health system, battered by conflict and neglect, was not ready to manage maternal health amid COVID-19’s disruptions, especially during the first 2 months of the pandemic, and mothers endured many complications, says Bashir Ahmad Bhat, an associate professor at the University of Kashmir.
A study by Bhat’s Population Research Centre on the impact of COVID-19 on the utilization of maternal and child health services in India (which has been submitted to the government but not yet made public) found that most patients still registered for their antenatal check-ups at public health facilities during the pandemic. But transportation challenges, the high cost of medicines and delivery charges, and caesarian sections all increased, he says, creating more obstacles for the mothers of an estimated 120,000 babies born in Kashmir each year.
Meanwhile, specialized care for already-stressed pregnant women was nonexistent. “Women in advanced stages of labor have been refused treatment, referrals have been delayed and they have been pushed to travel several kilometers to deliver,” according to one frontline community health worker—an accredited social health activist (ASHA)—from the Kokernag area, who requested anonymity out of fear of reprisal.
In April 2020, the Directorate of Health Services in Kashmir issued a statement, threatening “strict action” against government servants who criticize the government’s efforts to combat the pandemic on social media or in the press. Still, in some instances, ASHA workers had to protest and argue with the nurses and doctors during the pandemic over treatment delays.
“In so many cases, we saw women were afraid of institutional deliveries due to the lack of respect and care,” the ASHA from Kokernag says. “But, those with poorer backgrounds have no option other than to avail public health institutions, especially in rural areas.”
As women limited their regular visits during the pandemic, ASHAs tried to provide services and education at home, according to Bashir Ahmad Bhat. “Postpartum care suffered a lot as women were discharged almost within 2 days after their deliveries to avoid infection,” he says, rather than the usual stay of 3 days. “Women with high-risk pregnancies became more vulnerable, and many developed complications.”
Private hospitals during the peak of the lockdown mostly denied treatment to pregnant women or for any post-delivery complications for mother or child, according to another ASHA from the Pulwama district (who also requested anonymity). In one case, she said, a woman went into labor and was denied treatment until the hospital received her COVID-negative test.
“It was her sheer luck that we collected the report by hand and submitted it to the hospital immediately,” says the health worker. “Later, when her child developed complications, there was a delay in referral and we again had to intervene and literally threaten the ambulance driver to ferry us fast to the children’s hospital.”
As for Javed, hospital records list postpartum hemorrhage and cardiac arrest as the underlying conditions that caused her death. There is no mention of any COVID-positive test in her records. The family couldn’t follow-up with any legal investigation, as their area was kept under COVID-19 lockdown containment for more than 3 months—and they did not receive any official medical record for Javed.
Despite weeks of attempts to reach the Kashmir Directorate of Health Services as well as health officials in Anantnag, the authorities refused to answer any questions on the record. However, an official from the directorate office, on the condition of anonymity, says that due to a lot of criticism from the media and frequent protests by the local population, they prefer not to comment on sensitive issues. He admitted, though, that due to gaps in timely health services, people have suffered. Some common complaints include the lack of transport, delay, and denial of maternal health care.
Padroo says that the media reported his wife’s case as COVID-positive—but later, a sample showed she was negative along with every family member.
“She died because she was treated as a positive case and didn’t receive any treatment,” Padroo says. “The entire hospital staff was heartless, and they let her die.”
Ed. Note: This article and Part 1, In Kashmir, Coronavirus Pushed Already-Broken Maternal Health over the Brink, are part of Global Health NOW’s Local Reporting Initiative, made possible through the generous support of loyal GHN readers.