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May 7: India is projected to record the highest number of births in the 9 months since COVID-19 was declared a pandemic in March, with more than 20 million babies expected to be born in the country between March and December, according to top UN body.

The United Nations Children's Fund (UNICEF) warned that pregnant mothers and babies born during the pandemic across the world were threatened by strained health systems and disruptions in services.

An estimated 116 million babies will be born under the shadow of COVID-19 pandemic, UNICEF said on Wednesday, ahead of Mother's Day, observed on May 10.

These babies are projected to be born up to 40 weeks after COVID-19 was recognised as a pandemic on March 11.

The highest numbers of births in the 9 months since the pandemic was declared are expected to occur in India, where 20.1 million babies are projected to be born between March 11 and December 16. Other countries with the expected highest numbers of births during this period are China (13.5 million), Nigeria (6.4 million), Pakistan (5 million) and Indonesia (4 million), it said.

"Most of these countries had high neonatal mortality rates even before the pandemic and may see these levels increase with COVID-19 conditions," UNICEF said.

It is estimated that there will be 24.1 million births in India for the January-December 2020 period.

UNICEF warned that COVID-19 containment measures can disrupt life-saving health services such as childbirth care, putting millions of pregnant mothers and their babies at great risk.

Even wealthier countries are affected by this crisis. In the US, the sixth-highest country in terms of the expected number of births, over 3.3 million babies are projected to be born between March 11 and December 16.

"New mothers and newborns will be greeted by harsh realities," UNICEF said, adding they include global containment measures such as lockdowns and curfews; health centres overwhelmed with response efforts; supply and equipment shortages; and a lack of sufficient skilled birth attendants as health workers, including midwives, are redeployed to treat COVID-19 patients.

"Millions of mothers all over the world embarked on a journey of parenthood in the world as it was. They now must prepare to bring a life into the world as it has become – a world where expecting mothers are afraid to go to health centres for fear of getting infected, or missing out on emergency care due to strained health services and lockdowns," UNICEF Executive Director Henrietta Fore said.

"It is hard to imagine how much the coronavirus pandemic has recast motherhood" Fore said.

UNICEF said its analysis was based on data from World Population Prospects 2019 of the UN Population Division.

An average full-term pregnancy typically lasts a complete 9 months, or 39 to 40 weeks. For the purposes of this estimate, the number of births for a 40-week period in 2020 was calculated.

The 40-week period of March 11 to December 16 is used in this estimate based upon the WHO's March 11 assessment that COVID-19 can be characterised as a pandemic.

UNICEF warned that although evidence suggests that pregnant mothers are not more affected by COVID-19 than others, countries need to ensure they still have access to antenatal, delivery and postnatal services.

Similarly, sick newborns need emergency services as they are at high risk of death. New families require support to start breastfeeding, and to get medicines, vaccines and nutrition to keep their babies healthy, it said.

"This is a particularly poignant Mother's Day, as many families have been forced apart during the coronavirus pandemic, but it is also a time for unity, a time to bring everyone together in solidarity. We can help save lives by making sure that every pregnant mother receives the support she needs to give birth safely in the months to come," Fore said.

Issuing an urgent appeal to governments and health care providers to save lives in the coming months, UNICEF said efforts must be made to help pregnant women receive antenatal checkups, skilled delivery care, postnatal care services, and care related to COVID-19 as needed.

Ensure health workers are provided with the necessary personal protective equipment and get priority testing and vaccination once a COVID-19 vaccine becomes available so that can deliver high quality care to all pregnant women and newborn babies during the pandemic, it said.

While it is not yet known whether the virus is transmitted from a mother to her baby during pregnancy and delivery, UNICEF advised all pregnant women to follow precautions to protect themselves from exposure to the virus.

Closely monitor themselves for symptoms of COVID-19 and seek advice from the nearest designated facility if they have concerns or experience symptoms. Pregnant women should also take the same precautions to avoid COVID -19 infection as other people: practice physical distancing, avoid physical gatherings and use online health services, it said.

UNICEF said even before COVID-19 pandemic, an estimated 2.8 million pregnant women and newborns died every year, or 1 every 11 seconds, mostly of preventable causes.

The agency called for immediate investment in health workers with the right training, who are equipped with the right medicines to ensure every mother and newborn is cared for by a safe pair of hands to prevent and treat complications during pregnancy, delivery and birth.

May 28: Abdul Kareem was forced out of school and into a life of odd jobs like repairing bicycles before he finally managed to pull his family out of abject poverty transporting goods across Delhi in a mini truck.

The job, and the slim financial security that came with it, was the first stepping stone to a better life.

All that is now gone as India reels under the economic impact of its protracted coronavirus lockdown. Mr Kareem's out of a job and stranded in his village in Uttar Pradesh with his wife and two children. Their minuscule savings from his Rs 9,000 a month job have been exhausted, and the money he saved for books and school uniforms is spent.

"I don't know what the job situation will be in Delhi once we go back," Mr Kareem said. "We can't stay hungry so I will do whatever I find."

At least 49 million people across the world are expected to plunge into "extreme poverty" -- those living on less than $1.90 per day -- as a direct result of the pandemic's economic destruction and India leads that projection, with the World Bank estimating some 12 million of its citizens will be pushed to the very margins this year.

Some 122 million Indians were forced out of jobs last month alone, according to estimates from the Center for Monitoring Indian Economy, a private sector think tank. Daily wage workers and those employed by small businesses have taken the worst hit. These include hawkers, roadside vendors, workers employed in the construction industry and many who eke out a living by pushing handcarts and rickshaws.

For Prime Minister Narendra Modi, who came to power in 2014 promising to lift the poorest citizens out of poverty, the fallout from the lockdown brings with it significant political risk. He won an even larger second term majority last year on the strength of his government's popular social programs that directly targeted the poor, such as the provision of cooking gas cylinders, power and public housing. The breadth and depth of this renewed economic pain will only increase the pressure on his government as it works to steer the country's economy back on track.

"Much of the Indian government's efforts to mitigate poverty over the years could be negated in a matter of just a few months," said Ashwajit Singh, managing director of IPE Global, a development sector consultancy that advises several multinational aid agencies. Noting that he did not expect unemployment rates to improve this year, Singh said: "More people could die from hunger than the virus."

Desperate Times

Mr Singh points to a United Nations University study estimating 104 million Indians could fall below the World Bank-determined poverty line of $3.2 a day for lower-middle-income countries. This will take the proportion of people living in poverty from 60% -- or 812 million currently, to 68% or 920 million -- a situation last seen in the country more than a decade ago, he said.

A World Bank report found the country had been making significant progress and was close to losing its status as the country with the most poor citizens. The impact of PM Modi's lockdown risks reversing those gains.

The World Bank and the CMIE estimates were published in late April and early May respectively. Since then the situation has only become grimmer, with harrowing images of people making desperate attempts to reach their villages, on crowded buses, the flatbeds of trucks and even on foot or on bicycles dominating media coverage.

The Rustandy Center for Social Sector Innovation at the University of Chicago Booth School of Business analyzed the unemployment data from the CMIE, collected through surveys covering about 5,800 homes across 27 states in April.

Researchers found rural areas were the hardest hit, and the economic misery was the result of the lockdown, rather than the spread of infections in the hinterland. More than 80% of households had experienced a drop income and many won't survive much longer without aid, they wrote in a report.

The government has promised cheap credit to farmers, direct transfer of money to the poor and eased access to food security programs -- but these help people who have some documentation, which many of the poorest don't. With millions of impoverished people now in transit across the country, the food security situation is dire -- news reports are emerging of people foraging through piles of rotting fruit or eating leaves.

Shattered Economy

The economy was already growing at its slowest pace in over a decade when the virus struck. The lockdown, which came into effect on March 25, has hammered it, stalling business activity and putting a lid on consumption, pushing the economy to what may be its first full-year contraction in more than four decades.

It's dire enough to warrant the country exiting its lockdown, as it has been doing incrementally since May 4, even as its infections are surging. India is now Asia's virus hotspot with infections crossing 151,000 according to data from Johns Hopkins University.

PM Modi, who has come under criticism for the pain inflicted on the poor, has said his government will spend $265 billion or about 10% of its GDP to help Asia's third-largest economy weather the pandemic's fallout. But experts say only a part of it is direct fiscal stimulus, and probably smaller than the total damage done to the economy during the lockdown period.

"What is especially worrying is the government's response," said Reetika Khera, an economics professor at the Indian Institute of Technology in Delhi. "The epidemic will magnify existing -- and already high -- inequalities in India."

Still, the economic measures aren't going to kick in for some time and industry will likely struggle to restart because of the flight of labour from industrial hubs.

And as the harsh summer unfolds more pain lies in store in the villages now dealing with returning migrant workers.

"There are no factories or industries here, there are just hills," said Surendra Hadia Damor, who had walked nearly 100 km from Ahmedabad, Gujarat, before a voluntary organisation drove him to his village in the neighboring state of Rajasthan. "We can survive for a month or two and then try and find a job nearby -- we will see what happens."