It was a bustling morning at Delhi’s Safdarjung Hospital on July 19. On the footpath outside the gynaecology department’s emergency ward, Poonam, 21, groaned in pain while her relatives cried and begged for help. Poonam was in labour, but the hospital staff wouldn’t attend to her, let alone admit her.

She had arrived the afternoon before, referred by a hospital in Nithari in Noida Sector 30. Poonam was expecting her first child. “We did all the paperwork the same evening. But the doctor just prescribed her a few medicines for pain, and asked us to wait outside,” said Jaysender, Poonam’s brother–in–law, who was accompanying her.

As evening turned to night, Poonam’s mother-in-law Jasoda recalled, the expectant mother was crying in pain. “I asked the hospital staff to do something, but they said they could do nothing at that hour and asked us to stay outside,” Jasoda claimed.

They kept insisting, however, and were directed to the fourth floor for an ultrasound, Jasoda said. “We took her there and waited until 10 pm, and then we were told the machine wasn’t working.”

The family, who live in Noida’s Dadri, were sent out again and they ended up spending the night on the footpath, awake and helpless.

By now Poonam was howling in pain. Her relatives repeatedly begged the staff and the security guard at the gynaecology department to let them in, to no avail. “Just stay outside like everyone else,” Jasoda said a security guard told her when she complained that Poonam’s condition was worsening.

Morning broke and still no help came. “They told us to take the patient on our own for an ultrasound and that they would start treatment after that,” Jasoda said. “We were waiting for her husband to arrive and take her but she started delivering the baby.”

It was around 9.30 am.

A video published on social media shows a group of women screening Poonam with a saree as others help her deliver the baby – right there on the footpath.

“Is this why we were sent here?” Josoda asked, her face ashen with grief and helplessness. “Everybody around was watching as she gave birth. Is this what we deserve?”

The video appears to show a few nurses attending to Poonam and her baby, but Rabia Singh, who made the now-viral video, told Newslaundry that they did not arrive until after the baby was born and only cut its umbilical cord.

Rabia, a Delhi High Court lawyer, was coming out of the emergency ward after admitting an accident victim when she noticed Poonam’s family screaming for help. “The lady was in labour and crying for help. But there was no hospital staff to take care of her. She delivered the baby right there on the footpath outside the emergency ward,” Rabia said.

The commotion did eventually draw out the hospital staff, and they took Poonam and her baby inside and admitted them. Both are fine now, Poonam’s family told Newslaundry.

The hospital has since denied that Poonam was turned away when she needed medical attention, but nevertheless announced an enquiry. “As Safdarjung Hospital has no refusal policy, she was examined by a Senior Resident doctor on duty at 5.45 pm…and her condition was found to be 33+6 weeks gestation with preeclampsia in early labour,” the hospital said in a statement. “The patient was offered admission but she didn’t return with the admission paper.”

SV Arya, the medical superintendent, did not respond to a request for comment.

Safdarjung Hospital is considered to be one of Delhi’s leading facilities for obstetrics and gynaecology care, conducting around 100 deliveries every day. Poonam’s plight, however, underlines the abysmal condition of maternal healthcare even in the national capital, and beyond. Indeed, cases like Poonam’s have been reported in the past. In February 2020, a woman in Uttar Pradesh’s Bahraich had to give birth on a street outside the hospital after the doctors refused to admit her. The year before, a similar incident happened at the Ram Manohar Lohia Hospital in UP’s Farrukhabad.

According to a bulletin released by the Registrar General of India in March, India’s maternal mortality rate improved to 103 per lakh live births in 2017-19 from 113 in 2016-18. However, it is still a long way from achieving the target rate of 70 as set in the United Nations Sustainable Development Goals.

A 2022 study, called “India Health System Review”, by the Asia Pacific Observatory on Health Systems and Policies found that “inequality in access to maternal healthcare services remains a major factor influencing maternal mortality, with institutional deliveries being seen as critical for safe outcomes for women who deliver and their newborn children”. Access to institutional deliveries, however, is influenced by socioeconomic status: rich, urban and educated women have higher levels of access to maternal and child health services as against poor, rural, uneducated women.

India is similarly nowhere near reducing its infant mortality rate to the Sustainable Development Goals target of 12 or less per 1,000 live births. It was 30 as of 2019. The infant mortality rate too is influenced by how rich and educated the mother is. A 2019 study, based on data from National Family Health Survey 2015-16, concluded that the higher the mother’s education and income levels the lower the infant mortality.