Remember the needs of pregnant women in virus war

It is almost inevitable that the Covid-19 pandemic will leave major scars in many countries’ health systems.

As it spreads across the world, it is creating a massive public health problem, with those most vulnerable bearing the brunt of its effects.

It is no news that the pandemic is leaving health systems stretched in the rush to control its spread while attending to the already affected populations.

This means other health services may suffer the consequences of neglect as efforts are reorganised to bring the disease to a halt.

A key component in the management of any infectious disease outbreak is the care of most-at-risk and vulnerable populations.

These include pregnant women, newborns, young children, nursing mothers, people living with disabilities, the elderly, refugees, and migrants.

Covid-19 is not an exception, with of most its casualties being the elderly, those with pre-existing conditions, the pregnant and young children.

Previous epidemics of many emerging viral infections have typically resulted in poor maternal health outcomes.

A case in point was the 2014-2016 Ebola crisis in Guinea, Liberia and Sierra Leone, which left many pregnant women casualties of one of the worst epidemics to hit these West African nations.

BLEAK FUTURE

Many women stayed away from health facilities as a result of quarantine restrictions or myths and misconceptions about the virus’ transmission, and were forced to take the riskier route of home deliveries.

Although most of the human coronavirus infections have been mild, according to studies, the severe acute respiratory syndrome coronavirus (Sarc-CoV) and Middle East respiratory syndrome coronavirus (Mers-CoV) epidemics of the past two decades were especially grave, with approximately a third of infected pregnant women dying from the illness.

To prevent a massive outbreak and curb transmissibility of the disease, many governments the world over, including here in Kenya, have put in place critical measures to reduce exposure and transmission of the virus across populations.

While these actions have been designed to slow the spread of the disease, there has been little consideration in terms of messaging about the realities of the most vulnerable populations, including pregnant women.

With an estimated 3.6 billion people worldwide lacking access to essential health services and a shortfall of 12.9 health workers globally, according to the World Health Organisation, the current crisis will no doubt be an added burden to different clusters of the population, given their susceptibilities and the realities of the already overstretched health care systems.

Though hospital visits may increase the chance of infection, the lack of proper healthcare during pregnancy and childbirth may lead to worse consequences, including unwarranted deaths and lifelong disabilities.

SUSTAINING GAINS

According to 2019 WHO maternal mortality estimates, about 810 women died every day from preventable causes related to pregnancy and childbirth in 2017, with 94 per cent of all maternal deaths occurring in low and lower middle-income countries like Kenya.

Kenya has made gains in the fight to end maternal mortality, according to recent estimates, with a recorded drop to 5,000 annual maternal deaths.

For these gains to be sustained, there must be a deliberate, focused and responsive prioritisation of essential and quality reproductive maternal newborn and child health (RMNCH) services during the current global crisis.

Women living in poverty face more vulnerabilities, with discrimination, exclusion and marginalisation on access to and utilisation of maternal health services being a norm.

With Covid-19’s indiscriminate and sustained spread across continents and within countries like Kenya, we are likely to see pregnant and nursing women infected across all trimesters of pregnancy.

RMNCH services are critical and need not be overlooked during any crisis. This is because even in such times, sexual reproductive health services, like any other health services, will be needed.

Further, pregnant women will need antenatal care services, they will deliver, and complications will most likely arise like in normal times.

Hence, a well-managed response system in healthcare — one that does not lock out the existing systems, and which allows women access to essential reproductive maternal health care services with minimum exposure to risk is critical during this pandemic — is important.

KEY ISSUES

This will require a deliberate and sustained focus not to neglect these vulnerable groups of the population.

It is essential that protocols for pregnancy and childbirth during the pandemic are evidence-based and uphold the human rights of all women and their newborn.

The WHO website has this updated on a rolling basis for different audiences to learn from.

The White Ribbon Alliances-led "What Women Want Campaign" (2019) unearthed critical issues that need prioritisation for quality reproductive health to be realised in Kenya.

Water, sanitation and hygiene in healthcare facilities — a top preventive measure in the current pandemic — respect and dignity, security for mothers and newborns, and provision of right information and menstrual hygiene were pointed as critical aspects that must be addressed to achieve positive maternal health outcomes.

These need to be integrated in the current Covid-19 responsiveness. They should be coupled with the availability of an adequate, competent, supported and protected health workforce, which will be key to ensuring these services are available as and when needed.

The government of Kenya should ensure that systems are instituted to facilitate access to essential reproductive maternal child health services, even in the prevailing travel restrictions and curfews.

Failure to give these services the priority they deserve will leave more far-reaching consequences, including reversing the gains made so far in reproductive maternal newborn and child health.

Ms Nguku is the founder and executive director of White Ribbon Alliance Kenya; [email protected]