Govt data shows surge in people dying without any medical attention in 2020

Fewer women gave birth in institutional settings amid pandemic

About 45 out of every hundred people whose deaths were captured in government data had died without receiving medical attention in 2020.

This figure for 2020 is 10.5 percentage points over the 34.5 per cent figure recorded for such deaths in 2019, the year before the pandemic (see chart 1). The deaths captured in the government’s annual report on Vital Statistics of India based on the Civil Registration System include all causes including Covid-19 and otherwise. Only around 28 per cent of people dying received some attention from a medical institution in 2020, it showed.

A perusal of earlier reports puts the figure at lower numbers before 2015. For example, it was under 20 per cent in 2011 and 2012. This may have to do more with the fact that registrations don’t capture all deaths. Data collection issues have come down of late, according to a 2019 study entitled ‘Completeness of death registration in the Civil Registration System, India (2005 to 2015)’ from authors G Anil Kumar, Lalit Dandona, and Rakhi Dandona of the Public Health Foundation of India.

“The completeness of registration of death (CoRD) in the Indian Civil Registration System (CRS) was assessed from 2005 to 2015… About 40 per cent increase in CoRD was documented for India between 2005 and 2015, with CoRD of 76.6 per cent in 2015,” it said.

Dileep Mavlankar, director, Indian Institute of Public Health, and former professor Indian Institute of Management Ahmedabad suggested that any fall in availability of medical assistance once the registration data is uniform would be a pointer towards health infrastructure or poverty issues.

A similar trend of lack of access to medical facilities was also seen during births. Only 74 out of 100 women who gave birth did so in an institutional setting like a government or private hospital in 2020, compared to 81 in 2019 (see chart 2).

Giving birth in a hospital setting reduces the chances of the mother dying during childbirth, noted a 2021 study entitled ‘Effects of Covid-19 on maternal institutional delivery: Fear of a rise in maternal mortality’ from authors Rahman MA of Khulna University in Bangladesh, Henry Ratul Halder of the University of Manitoba in Canada and Sheikh Mohammed Shariful Islam from Deakin University in Australia. The study noted that there are 810 maternal deaths happening globally every day most of which can be prevented using safe institutional delivery.

“In 2019, about 80 million deliveries occurred at health institutions globally, but this number may be reduced in a post-pandemic scenario. Pregnant women who deliver at home have an increased risk of maternal mortality…..Evidence shows that 35% of all causes of antepartum, intrapartum and postpartum haemorrhage is due to unsafe home delivery practices,” it said.

A regional breakdown shows that the registration of both births and deaths still happen with a lag in many states. Fifty per cent or fewer births are registered within the prescribed 21 days in Uttar Pradesh, Manipur, Uttarakhand, Ladakh, Assam, Arunachal Pradesh and Nagaland. A similar list for deaths include Uttar Pradesh, Uttarakhand, Jammu and Kashmir, Nagaland, Manipur, Ladakh, Assam and Arunachal Pradesh.