Pregnant women and their babies are suffering worse outcomes during the COVID-19 pandemic, and researchers are sounding the alarm for immediate action to avoid rolling back decades of global investment in safe maternity care.
Data from an analysis of 40 studies published during the last year across 17 countries found rates of stillbirth and maternal mortality increased by a third. Outcomes were worse in low- and middle-income countries, according to a report Wednesday in The Lancet medical journal.
The increases may be driven by the pressure COVID-19 put on health systems rather than measures aimed at limiting the spread of the virus, such as lockdowns, the researchers said. Studies from individual countries suggested pregnant woman reduced their care-seeking because of the fear of infection, as well as reduced provision of maternity services.
“It is clear from our study and others that the disruption caused by the pandemic has led to the avoidable deaths of both mothers and babies, especially in low- and middle-income countries,” said Asma Khalil, lead author of the study at St. George’s University of London.
The meta-analysis included studies from countries including Botswana, Brazil, Canada, China, Denmark, India, Israel, Mexico, Nepal, the U.K. and the U.S. Though the report is the first global assessment of the collateral impact of the pandemic on maternal and child health, it has its limitations. Studies included in the analysis varied in their methods, making it more challenging to compare results.
The outcomes represent a reversal of recent progress toward making pregnancy safer for mothers and children worldwide, said Andreea Creanga, physician and associate professor in the Department of International Health & Department of Gynecology and Obstetrics at Johns Hopkins University.
The world had made progress in ensuring antenatal care and deliveries in health facilities staffed by health workers, and the focus had shifted in recent years to increasing the quality of the care that women and babies received.
“Now, we are going to go back and make sure that women come to facilities to get the care they need for themselves and for their infants,” she said. “It’s a difficult road ahead.”
In Sierra Leone, which until recently had the highest maternal mortality ratio in the world and had suffered an outbreak of deadly Ebola, government officials and partners have taken pains to ensure access to routine health services.
Utilization of health services dropped during the Ebola outbreak because of fear and economic instability, so the country acted quickly this time, said Jonathan Lascher, executive director of Partners In Health in Sierra Leone, an organization that has worked in partnership with the Ministry of Health to support the health system over the last six years.
“We took to the radio waves, and we started talking about the fact that the hospital and clinics that we support are open,” said Lascher. “People should be continuing to come and that it’s safe.”
There was an initial drop in antenatal care and routine visits to the hospital, said Isata Dumbuya, a nurse midwife and manager of maternal and child health for PIH.
“Bear in mind that this is a region that lived through a very serious Ebola epidemic, and they still have very poor memories of what happens when you come to a hospital or when there’s a pandemic breaking out,” said Dumbuya. “People stayed away for that reason.”
Since then, through ministry and others’ efforts, visits have resumed as awareness of COVID-19 and its risks have become clearer for the population. But Dumbuya said she’s concerned about the impact of supply constraints and funding on the maternal and child health in the country.
Budget cuts in major aid programs have already begun to impact other programs in the country, resulting in maternal health providers pulled from their units, she said.
“This is how our women and patients will suffer, not as a direct consequence of COVID-19 but an indirect consequence,” she said. “If our suppliers can no longer ship out the resources that we need on time or if our donors can no longer contribute the same amount of funding that they used to, then we cannot sustain these programs on our own.”