Women in 45 Countries Experiencing Traumatic Births: Covid-19 Threatens Maternal Health in African Countries

Maternal mortality, which is the death of women during pregnancy or childbirth particularly from obstetric complications, has been a long-standing public health challenge for many African countries. In light of the recent COVID-19 pandemic, new evidence has emerged from Open Democracy that shows a link to the rising number of maternal deaths. These links, while indirect, are having a devastating impact on thousands as access to life-saving services have been interfered with. 

Granted, Covid-19 mitigation measures including the government- imposed lockdowns were deemed essential to curb the spread of the virus but this has left women particularly vulnerable. One would not have known the potential risk to women and children this would have incurred. In many countries, a combination of the restrictions on movement, lockdown, the ban on public transportation and the overstretched healthcare systems led to a significant decline in access to essential maternal healthcare services. 

“The safest place for a woman to deliver her baby is at a functional health facility with a skilled birth attendant. However, during this global crisis, many women may end up delivering at home without appropriate support” the United Nations International Children’s Fund (UNICEF) noted.

Similarly, the newly emerged data from Open Democracy found that women in at least 45 countries experienced a “traumatic” birth as a result of the pandemic’s effect on health care delivery and access. In addition to this were reports of cases in Africa where women have either been turned away by healthcare workers or women who were forced to give birth in unsanitary conditions while trying to receive medical attention. These were especially the case for three African countries; namely Kenya, Nigeria and Uganda. The restrictions on movement amidst the pandemic is also said to be linked to the death of women in six African countries. This includes Nigeria. In Abeokuta, a pregnant woman died in a gynaecology emergency department. She reportedly showed COVID-19 symptoms that led healthcare workers to “abandon” her for hours. 

According to UNICEF “pregnant women and mothers with newborns may experience difficulties accessing services due to transport disruptions and lockdown measures or be reluctant to come to health facilities due to fear of infection”. 

By the World Health Organisations’ (WHO) estimates even a minimal 10% decline in maternal and newborn health (MNH) service coverage leads to an additional 28,000 maternal deaths and 168,00 newborn deaths. As it stands already the rates of maternal mortality are high bearing in mind this is classed as a preventable death. According to the World Health Organisation maternal mortality, Sub-saharan Africa and Southern Asia accounted for 86% of the global maternal deaths in 2017 with sub-Saharan Africa constituting two-thirds of maternal deaths. Furthermore, but unsurprisingly, all evidence points to the fact that maternal mortality is predominantly a health challenge for low- and middle-income countries. Nigeria falls squarely within these two categories as a sub-Saharan African country and a lower, middle-income country. 

In recent years, maternal mortality has seen some improvements. The indicator of maternal mortality is illustrated by the maternal mortality ratio (MMR). The MMR in less-developed countries decreased by roughly 50%. The 2018 Nigeria Demographic Health Survey (DHS) showed that Nigeria’s MMR is 512 maternal deaths per 100,000 live births. 

The effects of Covid-19 restrictions will have vast consequences in health and development. Indeed human rights lawyers warn that lawsuits may follow. Health experts also forecast tens of thousands of women in impoverished countries will die due to the impact of Covid-19 on health systems and the subsequent decisions by countries to put in place movement restrictions. This also has consequences for the achievement of Sustainable Development Goals in countries that are already lagging behind. 

With the numbers rising, Covid-19 is still a present issue and therefore, the impact in addition. Actions must be taken to effectively work around the pandemic while it is ongoing. Take the 2014 ebola outbreak, for example, evidence from The Lancet showed that the indirect effects of the outbreak surpassed the outbreak itself. During the ebola outbreak, antenatal services decreased by 22%, facility deliveries decreased by 8% and postnatal services by 13%. 

It is in recognition of the potential effects of Covid-19 that the WHO provided operational guidelines for maintaining essential health services and adapting services to prevent disruption. 

UNICEF also recommended that countries reallocate human resources such as nurses and midwives from healthcare services delivery to an intentional response effort. Countries were also urged by UNICEF to maintain quality maternal and healthcare services. It is paramount that even while the pandemic is being tackled, antenatal, childbirth and postnatal care services are available to women at all hours. 

In addition to WHO and UNICEF’s directive, it is our recommendation to the Nigerian government that to prevent unintended effects that the restriction begets, that there are sufficient healthcare workers in the first place so that midwives are readily available. Further, it is our belief that had healthcare workers been provided adequate Personal Protective Equipment (PPE), they might not turn away women, as they would have no cause to fear contracting Covid-19.