Pregnancy: a time of joy transformed to worry
Covid-19 brings fresh complications to pregnancy and childbirth across Eastern and Southern Africa, writes Dr Gabriele Fontana .
Clementine* is 36 weeks pregnant. She lives in Johannesburg, South Africa and says this has been the scariest time of her life. She has lost her income as a result of the current lockdown and worries for herself and her unborn child. Her last antenatal visit was both costly and chaotic.
“There was no public transport, so I had to use an Uber. When I got to the clinic where I had registered, they could not see us pregnant ladies. There were a lot of patients there and they said they did not want to put us at risk,” says Clementine.
“So, with a mask over my mouth, a sanitising spray in my hand, and a prayer in my head, I went to another clinic. It was packed. I had no choice but to queue. My pre-natal tablets were finished so I waited for my turn. There was no social distancing measures in place at all, though the nurses tried to sanitise our hands.”
Her fears are shared by too many mothers today, though her story is not the worst.
While South Africa has the highest number of Covid–19 cases in the region, it also has one of the best public health systems.
Across Eastern and Southern Africa, pregnancy is often an anxious time. In the rural parts, hospitals are often far away, skilled midwives are few and the odds of life against death remain eerily close. In towns and cities, the challenges have a different nuance: nurse midwives are frequently overwhelmed, and most maternity and neonatal wards are crowded and hardly equipped to handle any complications in childbirth.
Public health systems across the poorest countries of Africa – grossly inadequate to begin with – are already battered by challenges such as limited capacity, staff attrition and a lack of obstetric care equipment. But none of these are creating greater anxiety in Africa than the growing Covid–19 pandemic.
The fear is, combined, Covid–19 containment measures such as lockdowns and curfews, health centres that are overwhelmed with the Covid-19 response, equipment shortages and a lack of skilled birth attendants, can unravel the gains made on reducing maternal mortality and neonatal mortality.
Over the past few decades, the Eastern and Southern Africa region has seen progress in maternal and newborn survival. Deaths of newborns have fallen by a third. Similarly, the ratio of deaths for mothers during or following pregnancy has reduced by more than half. That’s been great news.
However, Covid–19 could undo such progress, with disruptions to the health system. Containment measures – necessary though they have been – have curtailed people’s ability to move and access hospitals and clinics. While these services remain open as ‘essential services’ accessing them has become problematic. In some cases, public transport to health care facilities is grounded, in some countries pregnant mothers and children need a police letter to go to the hospital. Furthermore, many mothers are quite simply scared to leave the house and go to a perceived high Covid–19 risk hospital or clinic.
Evidently, the process for accessing care has become complicated and risky.
In 2017, according to the United Nations Interagency Reports, the region lost 70 000 mothers and 441 100 newborns due to preventable causes. A recent study published in The Lancet estimated that in the same region Covid-19 containment measures – in case of a 45% reduction in coverage of routine health service – would bring an additional 186 200 deaths of children under the age of 5 and 11 360 maternal deaths. They are dire predictions, but possible.
It becomes critical then for governments and partners to ensure immediate investment in training and equipment for health workers, together with adequate stocks of medicines to ensure that every mother and newborn is cared for by a safe pair of hands.
Governments and health care providers across Eastern and Southern Africa can save the lives of mothers with a few determined actions.
First, ensuring health centres and community health workers are supported to continue providing accessible and timely essential health services, protected through local protocols for hand hygiene, respiratory etiquette, physical distancing, screening and other measures.
Second, resources should be mobilised by both government and the private sector to support continuity of essential maternal, newborn, child and adolescent health services, including support to maintain water, sanitation, and hygiene at health facility level.
Finally, communities should be engaged, and information shared on Covid-19 prevention, early treatment seeking, evidence-based self-care interventions (in line with local practice) and timely access to essential maternal, newborn and child health services.
Without a doubt the Covid–19 pandemic has brought fresh anxiety to the journey of pregnancy for mothers like Clementine. However, over the decades governments and communities have greatly improved on the care of pregnant mothers and newborns. This progress should not fall away during Covid–19. Rather, everyone should rally together and support expectant mothers and their babies during these trying times.
*Interviewee requested that only her first name be used for publication
Dr Gabriele Fontana is the regional health adviser for the United Nations Children’s Fund (Unicef) in the Eastern and Southern Africa regions.
For more information on Covid-19 in South Africa, you can call the toll-free line on 0800 029 999, or you can send a message that says “Hi” on WhatsApp to the number 060 012 3456. You can also visit the SA Coronavirus website.