Severe Midwife Shortage Cripples Maternal Care at Ludhiana Health Centers

Ludhiana's health centers are under increasing pressure due to a severe shortage of auxiliary nurse midwives (ANMs), which is disrupting services. While national standards recommend one ANM per 10,000 people, all major urban areas in the district are woefully short-staffed, putting an enormous strain on the staff and impacting the quality of maternal and child healthcare.

Only a Fraction of the Required Midwives are in Place

As per the National Health Mission (NHM) guidelines introduced in 2014, Ludhiana should ideally have at least 196 ANMs to serve an estimated 18-20 lakh population. Unfortunately, current statistics show that just 60 ANMs are currently working in Urban Primary Health Centres (UPHCs) of the district, only 30% of what is required.

The deficit results in each ANM caring for two to three times as many patients as initially intended, leading to burnout and a decline in care quality. The crisis is even greater in Giaspura UPHC, which covers around one lakh, but no longer has a single ANM. Salem Tabri, with 45,000 residents, also lacks a resident midwife. Dhandari and Model Town UPHCs serve populations of 60,000 and 31,000, respectively, each having a single ANM.

Urban Poor Most Affected by Lack of Midwives

A top health official, who did not want to be quoted, emphasized the urgent demand for ANMs in overpopulated urban slums, where the population has migrant workers as residents. They need concentrated outreach for prenatal education, detection of early pregnancy complications, and care for pregnancy complications, which the ANMs can provide.

The result of this deficit can be observed in the maternal mortality rates. Although 20 maternal deaths were registered in urban regions during 2023–24, the earlier years showed alarming trends: 18 deaths in 2021–22, up to 28 in 2022–23. Health among pregnant women remains at risk as there is no sustained support.

Repeated requests for ANM recruitment were disregarded.

Efforts to fill the gap are not recent. The health department in Ludhiana has been lobbying since 2018 for more ANM posts, repeatedly penning letters to top officials. Although there have been a few spurious postings, most of the approved posts are still lying vacant.

Ludhiana Civil Surgeon Dr. Ramandeep Kaur owned up to the issue by taking the case as a focal point at a civil surgeon's conference.

What has to happen now?

Critics emphasize the urgent need for Ludhiana to recruit, train, and retain more ANMs, particularly in the poor urban slums, to ensure equitable access to health care. The frontline workers are central to improving the city's maternal health statistics as well as promoting long-term public health goals. With prompt intervention and careful staff planning, the city can reverse the present trend and regain confidence in its basic health care system.

(Input from various sources)

(Rehash/Muhammad Faisal Arshad/MSM)