Situation That Emerged During ANC
A 34-year-old woman from a village in Uttarkashi district arrived at the local sub-centre for Antenatal Care (ANC) registration, where the Auxiliary Nurse Midwife (ANM) administered a Tetanus and Diphtheria (TD) vaccine. After receiving the injection, she lingered at the facility for a long time. While speaking with her, the frontline health worker realized she had severe difficulty expressing herself.
With help from the daughter accompanying her and the local Accredited Social Health Activist (ASHA), the health worker began piecing her background together.
Family Background
The woman lives with a speech and communication impairment that prevents her from articulating everyday needs and health concerns.
Because of her communication barrier, understanding her condition required deliberate, patient engagement—an effort that soon uncovered critical gaps in her antenatal care.
She is a mother of four. Her two eldest daughters are 16 and roughly 13 years old. Her 10-year-old third daughter has a 70 percent disability; unable to walk or speak, she depends entirely on others for daily living. A fourth daughter, now three, was given away to another family shortly after birth. The woman is now pregnant once again.
Her 64-year-old husband remains married to his 62-year-old first wife, with whom he has two adult, married daughters. Driven by the desire for a male heir, he married a second time—only to father four more daughters.
These complex domestic dynamics directly compromise the health, well-being, and care received by both the woman and her children. Because of her communication barrier, understanding her condition required deliberate, patient engagement—an effort that soon uncovered critical gaps in her antenatal care.
The situation highlighted an urgent need for proactive coordination among families, community health workers, and healthcare facilities when managing pregnant women with disabilities.
Missing Records and Lost Timelines
The woman did not have a Mother and Child Protection (MCP) card. When staff attempted to issue one, she could not state the date of her Last Menstrual Period (LMP). Her accompanying daughter could not understand the questions either, and the date of her previous delivery remained unknown.
Without an LMP, estimating gestational age proved nearly impossible. Gathering whatever details the ASHA could supply, the team initiated steps to complete her remaining clinical check-ups. The situation highlighted an urgent need for proactive coordination among families, community health workers, and healthcare facilities when managing pregnant women with disabilities.
Diagnostic Deficits at the Sub-Centre
Essential clinical evaluations were urgently required, but the sub-centre lacked basic diagnostic readiness. An inspection of the haemoglobin testing equipment revealed dead batteries in some devices and non-functional machines in others, making primary testing impossible on-site.
The woman weighed just 44 kilograms, signalling a high-risk pregnancy that demanded close nutritional and clinical monitoring. Recognizing their facility’s limitations, the staff arranged to refer her to the nearest Primary Health Centre (PHC) for a comprehensive ANC profile and blood work.
Public health services must be made structurally accessible and sensitive to women with disabilities.
The Reality of Checkbox Care
Even after completing her diagnostic profile at the PHC, a follow-up assessment revealed a glaring oversight: she had not been prescribed or provided Iron-Folic Acid (IFA) or calcium tablets. This exposed a common frontline blind spot—treating ANC registration as a bureaucratic formality rather than an entry point for essential clinical care and nutritional support.
Disability and Healthcare Access
The woman’s communication barrier left her effectively voiceless within the healthcare system, unable to independently report her obstetric history, menstrual timeline, or physical symptoms.
In such cases, a frontline worker’s responsibility cannot stop at routine registration and dispensing medicines. It requires active dialogue, collaboration with family members and ASHAs, and an empathetic effort to identify unspoken needs. Public health services must be made structurally accessible and sensitive to women with disabilities.
The Daughters’ Vulnerability
The circumstances of the household’s daughters demand focused intervention:
- The 10-year-old daughter: Living with severe disability, she requires continuous support for personal hygiene, basic nourishment, and daily care.
- The 3-year-old daughter: Relinquished to another family in infancy, the underlying social and financial pressures behind her surrender warrant careful examination.
- The older daughters: Their educational security, nutritional health, and future well-being remain fragile within a strained household.
The Cost of Son Preference
The husband’s second marriage was motivated entirely by the pursuit of a son. Having fathered only daughters with his first wife, this entrenched preference continues to dictate the family’s reproductive decisions, leaving the second wife repeatedly pregnant.
Son preference severely undermines women’s bodily autonomy and maternal health. Routine maternal healthcare must therefore integrate sensitive, sustained family counseling on the equal worth of girls, reproductive risks, and voluntary family planning.
Key Takeaways
A single antenatal visit brought to light the deep intersections of social pressure, communication barriers, and public health delivery. Because the patient could not easily speak for herself, uncovering her clinical needs demanded extra care and persistence.
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The lack of an MCP card, untracked gestational milestones, non-functional diagnostic tools, and omitted IFA and calcium supplements demonstrate why procedural, superficial ANC checks fail vulnerable mothers.
Frontline healthcare must move beyond administrative task completion. It requires listening closely, recognizing missed interventions, understanding household vulnerabilities, and ensuring continuous clinical support. Above all, health systems must ensure that a patient’s inability to speak never leads to her care being silenced.