A nurse carries a premature baby to his mother. PHOTO: AFP
With the globally raging pandemic showing no signs of slowing down, one of the most pressing yet neglected concerns amid this scenario is that of maternal and child healthcare. While the world fights the pandemic, diverting manpower and resources in an attempt to win the battle against it, maternal and child healthcare has taken a hit. The gravity of the issue can be assessed from the following statement by the Director-General of the World Health Organisation (WHO) Tedros Adhanom,
“The indirect effects of Covid-19 on these groups (women and children) may be greater than the number of deaths due to the virus itself.”
The United Nations Children’s Fund (UNICEF) estimates around 116 million babies will enter this world under the shadow of the Covid-19 pandemic. The countries expected to have a baby boom include not only China but the already population dense, India and Pakistan (with around five million births) reeling under the Covid-19 crisis, with over-stressed hospitals and crumbling healthcare facilities. Thus, the onset of the pandemic has raised the panic alarms among the medical fraternity who will have to deal with both the direct and indirect fallout of the Covid-19 crisis on maternal and child health. Here it is pertinent to discuss the various risks and consequences presented due to Covid-19 which are serving as invisible barriers preventing access to quality maternal healthcare.
Firstly, the global containment measures (lockdowns) brought along the disruption of the pharmaceutical supply chains that has led to delays in contraceptives as well as essential medication provisions. India accounts for more than 20% of global exports of generic medicines, but it restricted the exports of 26 drugs resulting in a major global shortage. Secondly, healthcare centres are overwhelmed with Covid-19 response efforts and facilities are flooded with patients which has directly put constrains on womens’ access to hospitals for regular prenatal check-ups. Above all, the lack of sufficient skilled birth attendants, plus the healthcare workers who have been diverted to treat Covid-19, has added to the miseries of expecting mothers. In Peshawar for instance, the entire gynecologist ward at a hospital was closed off due to the detection of Covid-19 in one of the staff members. This means that they will not be able to cater to around 50-60 deliveries and 20-30 C-Sections on a daily basis, which is indeed worrisome.
Thirdly, the fear and anxiety associated with stepping out of the house to seek healthcare advice and routine check ups amid such uncertain and precarious circumstances is another challenge. Before the pandemic hit, one out of five women across the world experienced anxiety and/or depression either during their pregnancy or after childbirth. These worrisome times could lead to an inflation in those numbers.
Fourthly, the pandemic has exposed the deep rooted prejudices embedded in our societies due to racial discrimination. Black women in America are three times more likely to die from pregnancy-related complications than white women. The disproportionate rates of poverty, glaring health disparities, and persistent structural racism in the medical field put them at a greater risk of not receiving due healthcare. These factors ultimately couple together to expose black women to greater risks and complications related to pregnancy.
Fifthly, 80 million children under the age of one are at risk of measles, diphtheria and polio as the fear surrounding Covid-19 has disrupted routine vaccination campaigns. For example, in April approximately 40 million children were unable to receive polio drops in Pakistan after the cancellation of the nationwide vaccination campaign. The pandemic indirectly poses a serious threat to the gains in child healthcare over the years.
But despite the apparent portrayal of a bleak situation on the ground, a number of steps can be taken to improve the access to quality healthcare services under these uncertain times. The government, alongside the private sector, can take an initiative to ensure home visits by healthcare workers to pregnant women and new mothers. This would continue to ensure the provision of basic care on time. Also, since the pandemic has caused a significant technological shift and forced many to move towards virtual networks, we can definitely incorporate mobile healthcare strategies for tele-consultations and make women centric applications for responding to maternal needs adequately. Pregnant women can be provided access to remote prenatal care even after the pandemic is over.
As a temporary alternative to ambulance services, which are heavily occupied these days, a safe and on-demand ride-hailing platform can be brought to use. It can connect pregnant women with reliable transport options in their vicinity. That way a large number of women would be able to get timely access to critical and life saving care. Furthermore, to ensure timely child immunisation the government can fund transportation to ensure outreach activities are not halted. Moreover, routine immunsation activities can be carried out at fixed locations by complying with the physical distancing measures.
As the pandemic continues to plague the world, a better approach in Pakistan particularly would’ve been to set up an adequate number of field hospitals which specifically deal with Covid-19 patients. Reserved healthcare facilities in each locality could have specifically catered to maternal healthcare needs and other diseases as well. Although medical students are taught to treat patients without regard for their class, colour, religion, or gender, there is still a need to revamp the medical curricula by inculcating set of ‘racial equity courses’ which emphasises inclusive healthcare for all. The pandemic has not only served to expose the lack of equity but also the vulnerabilities of our fragile healthcare system. These testing times have also provided us with an opportunity to address these concerns and to build a stronger, more inclusive and resilient healthcare system.
How Covid-19 is disrupting access to maternal and child healthcare
A nurse carries a premature baby to his mother. PHOTO: AFP