Bangkok — It happened a month ago. Seule hurried to the hospital in Dhaka, she needed urgent medical care. 25-year-old resident of Bangladesh has just had a home birth: it is believed that home birth is safer than in the hospital during a pandemic. But she began post-partum bleeding (it’s one of the main causes of maternal mortality worldwide), and therefore she no longer thought about the threat of Contracting Covid-19. Never thought about it and MAGURA Actor, the midwife that came to the aid of Sauli and saved her life, although no one in the hospital did not provide adequate personal protective equipment (abbreviated as PPE).
The birth of a child is a stressful time in a woman’s life under any circumstances. But during a pandemic, there is a new form of stress. Mothers do not know to ride to the hospital, where they are threatened by a coronavirus, the shortage of staff and ban on the presence of their parents, or to give birth at home, where medical complications risks for life often increase. This is just one example of how the need to combat the pandemic Covid-19 complicates the provision of basic health services makes women particularly vulnerable.
In all countries of the world, when the health system is overloaded and the first to suffer medical assistance to women, which leads to an increase of maternal and childhood illnesses and mortality. To illustrate these risks, we modelled the possible impact of the pandemic on three key services in the area of sexual and reproductive health (often abbreviated as SRH): childbirth with the presence of experienced health workers, including midwives; childbirth in medical institutions; access to contraception.
The low level of access to services in the sphere of SRH is a problem for many countries, including developed countries such as the USA. But in our analysis we focused on the 14 particularly vulnerable countries in Asia and the Pacific: Afghanistan, Bangladesh, Bhutan, Cambodia, India, Indonesia, Laos, Myanmar, Nepal, Pakistan, Papua New Guinea, Philippines, Solomon Islands and East Timor. In all of these countries have high maternal mortality rates over 100 deaths per 100 thousand live births, which is usually due to the low level of recourse to health services, such as childbirth in specialized health care institutions or by skilled attendants.
According to our model, the best is the scenario where the use of the above-mentioned three key services reduced by 20%. This will lead to a rise in maternal mortality by 17%, which is equivalent to increasing the number of women dying during childbirth on 25 493 only this year. In the worst scenarios, when use of services is reduced by 50%, maternal mortality will increase by 43% (or in absolute numbers by 68 422 of the dead women). A significant portion of this increased mortality will be attributed to the increase in the birth rate due to the reduction in access to contraception services.
Reducing access to contraception and family planning seriously aggravating the existing risks. The closure of the border and other failures in the supply chain can lead to reduction in the supply of contraceptives, which are often sold even in normal times. Travel restrictions due to quarantine may not allow women to go to a pharmacy or clinic, especially in cases when the services are family planning services are not recognized “Essentials.” And those women who have access to these services, may decide not to use them, because they will be afraid of Contracting coronavirus.
Together, all these factors can lead to a sharp increase in unmet demand for family planning in 2020. In our best-case scenario, the proportion of unmet demand will increase to 22%, and at worst — to 26%, compared with 18.9% for women of reproductive age in 2019. The reason is that women who previously had access to modern contraceptive methods, will lose the opportunity to receive this critical service. In other words, unmet demand for family planning could increase by 40% in only one year 2020. The result will be thousands of unplanned pregnancies in each of the 14 countries and increase risks to the health of millions of women and newborns.
However, all these figures are just the beginning. There is little doubt that the crisis Covid-19 this year will not end. Costs to the economy, health and well-being of women — will continue to increase. Made recent progress towards increasing the efficiency and inclusiveness of health systems, and improving gender equality can turn back the clock.
It is necessary to take actions that limit such negative consequences. At the 1994 International conference on population and development (ICPD) in Cairo, governments around the world pledged to provide SRH services to all. It is a commitment they reaffirmed last year at the summit of the ICPD in Nairobi. When planning emergency measures in the sphere of economy and health, countries should ensure that they comply with this obligation.
In particular, leaders should ensure that key medical staff, including midwives, will not be distracted from performing its primary mission is to help mothers and newborns, and that all the staff provided with necessary PPE. Authorities must also ensure access to contraceptives. Where possible, you should think about the introduction of telemedicine and other innovative approaches to the provision of medical services. The pandemic clearly showed us one thing: a huge, helping to save lives the potential of new technologies and Internet connection.
UN Secretary-General antónio Guterres absolutely called the crisis Covid-19 “greatest challenge” faced by the world since the Second world war. In order to pass this test, the leaders of all countries of the world must realize that because of the pandemic, although it affects everyone, will suffer most are those who have been marginalized, including women, ethnic minorities and the poor. That is why no strategy to combat the pandemic is not complete without ensuring permanent access to basic services for the protection of sexual and reproductive health for all.
David De Beni is an adviser on the Economics of healthcare in the Asia Pacific office of the United Nations Fund for population.
Federica Maurizio — analyst on sexual and reproductive health and human rights in the Asia-Pacific office of the United Nations Fund for population.