Demand for Non-Covid19 Public Health Services for Women, Children, Transgender, Disable and Senior Citizens gets Louder

Nisha Biswas

Women, children, transgender persons, people with disability and senior citizens is the most invisible population of the country. Though the harshest and extremely unplanned lockdown to prevent the spread of Coronavirus failed miserably, it brought 19million workers working and living away from home, the backbone of Indian economy, in public gaze. With the abrupt announcement of Lockdown and shutting of everything in four hours’ notice, all the modes of transportation coming to halt, these workers were left with no other option than to take roads to reach amongst their own people. Most of them were not even paid for the work they did prior to the lockdown. Men, women, children, infirm, disabled, old all took the road to walk hundreds of kilometers to reach the supposedly safe native home, they left years ago for a better livelihood and life.

12-year-old Jamalo Madkami died after walking 100kms in dense forests, in bhandarpal jungles, 50 Km away from her village.  15-year old Jyoti Kumari cycled her ailing father to the native place covering 1200Km. A young mother lugged a trolley bag with a young child sleeping on it. Shakuntala, a full term pregnant risked a walk of 1000Km, gave birth to a baby on the roadside, rested for an hour and then marched onward. Women were marching home with bundles of essentials on head and babies in lap.  Babies died of exhaustion, dehydration and without food in Shramik Specials. A toddler tried to wake his dead mother at Muzzafarpur platform, while the little older than him stood nearby.  27 Babies were born in Shramik Specials (trains). We don’t how many of them survived or How is Shankuntala and her new born. How are the children orphaned in the way? Are they being taken care of or are left to fend themselves.

The iron-fisted lockdown and the idea of suppression strategies such as ‘social distancing’ was supposed to buy time to prepare the health services for the surge in Covid cases, and not to reduce the total number of persons infected. The country failed miserably in aimed preparedness. It also failed to address the long standing need to fill the longstanding vacancies of doctors, nurses, paramedics in public hospitals and creating primary level services.. What actually happened is that it converted the anticipated threat of Covid-19 into widespread hunger, anxiety, and physical distress. 

As always in any adversity, women and children are the worst sufferers of pandemic related lockdown and continue to suffer even during various stages of unlock. Women, transgender persons and people with disabilities are the first to lose jobs, first to be out of social welfare schemes like NREGS (even the PM Garib Kalyan Yojana to overcome the economic impact of Coronavirus induced lockdown has little to offer), first to go hungry, first to be excluded and first whose special needs are neglected and the first to bear burden of extra household work and abuse. Their need for special health care is overlooked. Maternity wards were the first to be converted in Covid wards. Children vaccination program come to a halt, mid-day meal program (the only hot meal with some nutrition, for many) was stopped. Mental health care remains out of reach instead women, children, transgender, disabled are facing more of domestic violence with nowhere to go. The neglect is so rampant that the women, constituting more than 70% of healthcare workers, are not even provided with sanitiser, gloves or basic protection gears. These health care givers are not even recognized as workers and their meager payment too is irregular. Hundreds of them died while conducting door to door survey, tracing communities for COVID-19 symptoms, and spreading awareness amongst people for precautions, without proper training, PPE kits, and lack in supply of gloves, masks, and hand sanitisers. One wonders if this could have happened to nearly 50lakh Covid 19 male warriors!!!

There are stories of pregnant women denied hospitalisation for child birth or pregnancy induced medical interventions. Emergency medical care for non-Covid ailments and physical conditions like pregnancy is a complete NO-NO. With medical staff employed in Covid work, there have been instances where pregnant women have been refused treatment or admission to hospitals, or have been unable to reach hospitals due to non-availability of ambulances, leading to their death or that of the foetus. Most of the activities related to non-Covid medical conditions like family-planning programmes, vaccinations, and antenatal care were put on hold during the lockdown. The ASHA and Anganwadi workers, who are the primary care providers to pregnant women and new-borns, were overloaded with Covid related work. 90% of children has stopped visiting emergency care. The damage caused by COVID-19 over the last five months may therefore result in outbreaks of alarming diseases worldwide due to the issues with the manufacture and delivery of the vaccines.

According to the data with the MoHF, from April 1 to June 10, 2020 the national average of the estimated number of pregnant women registered with the MoHFW, was only 24.05 per cent, while that of new-borns was only 17.47 per cent. Which means that 76 per cent of the pregnant women and 83 per cent of the new-born children are nowhere in the data bank. What happened to the rest of the 76 per cent of pregnant women? Did they deliver in homes? Did they get medical care on time? Nobody knows! Scarier is the scenario of the infants. It is not known if the 83 per cent of the estimated childbirths (since April) have received vaccination and other required emergency medical care. The country does not know how many of them have survived as well. Putting vaccination programmes that could be essential to save lives on hold, measles and polio are the two diseases forecast to rise.

Many primary health care centres are either closed down or are converted into Covid-wards. Apart from the denial of medical services, pregnant women are exposed to high risk of infection with health workers at community level are not provided with PPE or even masks. The shear apathy and callousness of the Government towards mass-hunger, health and nutrition is shocking.

Unwanted pregnancy and the women’s agency for abortion is being silenced in the wake of pandemic. According to an estimate there will be more than a lakh of such pregnancy, meaning the country is going to see a surge in child birth unless the need for contraceptives and medical services are immediately addressed.  In India, every day  more than 4000 die of TB, which can be prevented by proper treatment and that  treatment too is stopped.

Transgender persons face further discrimination. The health of those going through surgical process, taking hormonal drugs is under grave crisis. The regular visit to doctors is nearly impossible. In the aggravated economic, social and political crisis, transgender and queer people are facing increased violence in natal families as well as in public space. Country’s health system is not equipped with infrastructure that can attend emergency health crisis of transgender persons.

Frequent visit to hospitals is a necessity for people with disability (PWD), which is rather impossible under the existing circumstances. Where on one hand most of the facilities that PWDs used to access are closed, access to the ones that are open for them are unreachable due to lack of conveyance. They are also consumer of assistive devices, batteries for wheelchairs, diapers for adults, gloves for the patients of arthritis are not available with inadequately stocked medicine shops.

Pressed with the above crucial issues 14 Feminist, student and human right organizations submitted a memorandum to the Principal Secretary of Health of the government of West Bengal in Kolkata on August26, 2020 with the “demand for restoration of public health services for women, children, transgender persons, people with disabilities and senior citizens”. 

Following demands were placed:

1. Restore and strengthen State Emergency Healthcare services, attending to various health needs of women, children, transgender persons and persons with disabilities.
2. Put all private health facilities under State’s control.
3. Make all Covid, non-Covid treatment free of charges.
4. Provide emergency health services, both mental and physical needs, to the survivors of domestic violence, hate crimes, social discrimination.
5. Start helpline services to attend health emergencies. The Telemedicine Practice Guidelines issued by the Indian Council of Medical Research don’t even mention reproductive health services.
6. Provide affordable transport for persons with non Covid-19 health needs.
7. Resume functioning of Anganwadi Centers. Regularize wages, ensure social security benefits to frontline health workers like that of ASHA and Anganwadi, who supervise nutrition, vaccination, immunization schedules of gestating, lactating mothers and children.
8. Immediate cash transfer in the accounts of mothers and children from undisbursed under ICDS and MDMS food security allowances.
9. Immediate payment of maternity benefit of Rs 6000/- under PMMVY in one instalment.
10. Universal coverage of entire state’s population with free ration for next one year, consisting of 10Kgs of food grains, 1.5Kg of Daland 800gm of cooking oil.
11. No discrimination on the ground of Covid-19 in reproductive healthcare. Ensure admission of pregnant women in State and private hospitals.
12. Ensure adequate supply of contraceptives and abortion drugs in all hospitals and clinics. Give wide publicity to the fact that abortion services are essential health services and women are not turned away.
13. During quarantine, State Lockdown or hospitalization, persons with disabilities, must have access to essential support services, personal assistance and transport to hospitals and clinics.
14. Allot a minimum of two beds for transgender persons in at least one hospital in each district for Covid and non-Covid health emergencies.
15. Ensure that the Transgender persons do not face hurdles to access hormonal drugs, medical and surgical services.
16. Immediately start functioning of the shelter homes for abused women, transgender persons and children.
17. Mental health experts should be included and the issue of mental health must be taken seriously for a holistic approach to health concerns, especially for women, transgender and other marginalized people and communities.

The memorandum was endorsed by Ahalya, AIPWA, AISA, Chitrangada, Dus Theke Dus Hazar (DTDH), Feminists in Resistance (FIR), Kolkata Anandam for Equality and Justice, Maitree, Nari Chetna, Refraction, Right to food and work, Shramjibi Mahila Samiti, Shramajibi Nari Mancha and Women against State Violence and State Repression (WSS)

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Sep 4, 2020