COVID-19 affects maternal health care

Maternal deaths increase as health workers shift to care for COVID-19 patients

Kampala, Uganda | PATRICIA AKANKWATSA | Uganda’s response to COVID-19 has negatively impacted maternal, child and neonatal health, according to data by the United Nations Population Fund (UNFPA).

The UNFPA says the biggest and longest lasting impact is seen in complications of pregnancy, stillbirths and low-birth weight infants likely due to delayed care-seeking behaviour.

Routine analysis of service delivery data by UNFPA shows that since the onset of the COVID-19 pandemic in Uganda in March 2020, there has been an increase in maternal deaths by 10.4%, from 1,089 in 2019 to 1,202 in 2020, according to the Health Management Information System (HMIS).

The current maternal mortality ratio in Uganda is 336 maternal deaths per 100,000 live births. Infant mortality is 43 deaths per 1000 live births, with 42% of the mortality occurring during the neonatal period.

In Uganda, around 2% of women die from maternal causes.Therefore 1 in 23 children die before reaching their first birthday, with 42% of the mortality occurring during the neonatal period.

This has been attributed to the delay to make a decision to seek, the delay to reach and the delay to receive appropriate obstetric and neonatal care at a health facility.

In Uganda, 97% of pregnant women attend at least one antenatal care visit. However, 60% of women in Uganda complete at least 4 out of the 8 recommended visits, and only 29% have their first visit during the first trimester.

Even though 74% of childbirths in Uganda are attended by skilled health personnel, 44% of women do not receive postnatal care within 2 days after childbirth.

This implies that these women do not have the opportunity of childbirth and postnatal care during the first week of life, resulting in the large number of newborns lost during this period. This is further exacerbated by the fact that in many cases, midwives’ positions in public health facilities are not filled, meaning that skilled providers of antenatal and safe childbirth are not available.

While giving a keynote address during a webinar about maternal deaths held on July 15th, Winnie Kizza, an advocate for justice, human dignity and good governance said that Ugandan women are at risk in light of the rising rates of the pandemic, especially women who are about to give birth and thus exposed to the risk of unexpected complications during or after childbirth.

“The risk increases with concerns about the lack of access to quality health care services and information, insufficient supplies, and the absence of health care providers and goods to respond to emergencies,” she said.

Angela Nakafeero, Commissioner of gender and women’s’ affairs at the Ministry of Gender, Labour and social development says that meeting health needs is affected by the deterioration of the situation during the COVID-19 pandemic.

“Measures such as closing places and other compulsory measures, clinical staff may be pre-occupied with the response of pandemic patients than providing health services to other patients. Or health centers may lack sufficient personal protective equipment to provide services safely,” she says.

Phiona Nyamutoro, the national female youth Member of Parliament, says that contraceptive prevalence rates in Uganda is one of the most important ways to achieve high levels of reproductive health but only 39% of adolescents have access to healthy family planningservices. And with the lockdown restrictions access to contraceptives has greatly reduced.

“ More than half of all pregnancies in Uganda are unwanted; a third of those cases end up in unsafe abortion due to a combination of economic and cultural challenges,” she says.

“Unsafe abortion and its complications account for 5% of maternal deaths in Uganda, and worse still, treatment of complications from unsafe abortion poses costs to the Ugandan health care system,” Nyamutoro says.

“On average, post-abortion care costs about US$130 per patient, and women’s use of abortion as a means of fertility control has increased recently in Uganda in the intervening years,” she adds.

Uganda is one of the countries with a high incidence of 314,300 abortions annually, representing 14% of all pregnancies, or 39 per 1,000 women aged 15-49, abortion rates within Uganda vary from region to other and range from 18 per 1,000 women in the western to 77 per 1,000 in Kampala. Kizza recommends the Ugandan government to continue the management of the COVID-19 crisis while focusing on basic medical services that care for the mother’s health.

“This can be done by stocking and supplying health care facilities and personnel with sufficient basic commodities to meet the women’s needs, especially the emergency while controlling the spread of the Coronavirus,” she says.Nyamutoro says that the government and other stakeholders must establish good and safe alternative transportation to allow women to access much-needed health care.

“This coordinated response must be able to address emergencies for all mothers and children”

“Matters to do with the maternal health of women cannot be solved by mere legislation. There must be strengthened linkages to ensure that pregnant mothers access the necessary facilities,” She adds.

She also says that the government and Ministry of Health should work closely with civil society organizations to raise public awareness of medical referral services during the COVID-19 lockdown and their right to quality health care.

Nakafeero advises that training and support should be given to health workers and supportive health care providers during the prevailing pandemic and providing all the necessary resources and systems to contain the spread of the virus safely and effectively while providing health care to other.

She adds that there is need to find alternative means to ensure that young people and girls have access to information and services related to reproductive health and rights.

“That is, the correct information must be disseminated on online platforms for easy access and to prevent the continued misinformation of young people and girls with cultural legacies and misconceptions about their health and reproduction.”

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