Citing the need to take precautions against Covid-19 infection, several states have curtailed outreach services for immunization and maternal health services such as ante-natal check-ups. Public health experts have warned that such a move could lead to an increase in maternal mortality and further lower the already low immunization levels in most states.In Uttar Pradesh, Bihar , Rajasthan, Kerala and Karnataka , governments have suspended outreach programmes like organizing of vaccination days or door-step services. Ante-natal check-up for pregnant women too has been suspended. Most states are offering vaccination in primary health centres, district hospitals, medical colleges etc. However, most health facilities are too far away and difficult for people to access, especially with the transport lockdown.“If parents could bring their children to hospitals for vaccination, what was the need to provide these services at the village level till now? A large number of children have already missed out on immunisation in the month of March and more will miss them in the coming days. This is unacceptable and we have demanded that state government restore services,” said Chhaya Pachauli of Prayas in Rajasthan.An estimated 26 million children are born in India each year, which is more than 71,000 babies each day. Curtailing immunization services even just for a couple of weeks would mean lakhs of newborns not receiving the required vaccines during this crucial period. Similarly, lakhs of mothers would be deprived of ante-natal care, one of the most important measures to reduce maternal mortality.Even in states where vaccination work has not been formally suspended, the additional Covid work imposed on ASHAs and assistant nurse midwives (ANMs) could effectively throw it out of gear. In Madhya Pradesh, for instance, immunization and maternal services have not been suspended, but ASHAs have been asked to track migrants from outside the state through home visits to check for symptoms of Covid-19. “Where will they have the time for immunization work and taking pregnant women for delivery and ante-natal check-up if they are doing house-to-house surveys?” asked Amulya Nidhi, co-convenor of Swasthya Adhikar Manch.Tamil Nadu is among the states that has suspended outreach service of vaccination. However, apart from asking parents to bring their children for vaccination to the nearest PHC, special vehicles have been organised to ferry mothers and babies on all Wednesdays. “We have the list of children due for vaccination. If they don’t turn up, we will be calling them,” said Dr A Somasundram, joint director state NHM. Similarly, the state’s close tracking of pregnant mothers means health officials know that 1.5 lakh pregnant women are due to deliver in the next two months and the state is ensuring that all maternal services are available for them. But few, if any, states have such systems.According to Unicef , during the outbreak of Ebola in Congo, while 2,000 died of the epidemic outbreak, double that number died of measles as immunization services were affected. There is apprehension in the public health community in India now that Covid might similarly end up leading to greater maternal and infant mortality.(with inputs from Pushpa Narayan in Chennai and Preetu Nair in Kochi