What's needed to ensure maternal health for women in vulnerable populations
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- Hundreds of women die every day from preventable causes related to pregnancy or childbirth.
- Increased awareness and engagement can ensure that pregnant women and mothers around the world have the information and support they need for maternal health.
Pregnant women, one of the most vulnerable groups in society, are particularly vulnerable when disaster strikes. The COVID-19 crisis is worsening conditions for women across the world, disrupting access to reproductive health services “at a time when women and girls need these services most” said Dr Natalia Kanem, Executive Director of the UN Population Fund (UNFPA).
Fulfilling the World Health Organization’s Strategies Toward Preventable Maternal Mortality (EPMM) and the Sustainable Development Goals (SDGs) to reduce maternal mortality reduction has never seemed more out of reach. In developing regions, according to data from the World Health Organization and UNPF, more than 800 women die every day from causes related to pregnancy or childbirth. That’s despite the fact that the majority of maternal deaths are recorded as being preventable. In addition, mother and baby should not just survive childbirth, but also thrive in well-guided and supported pre- and post-natal care.
COVID-19 is highlighting the hardships that mothers in vulnerable populations already face every day. But COVID-19 is also adding further complexities and challenges to maternal care. We need to bring awareness to and find solutions to better support pre- and post-natal care of mothers and babies during turmoil and poverty. We all have the means to help one way or another.
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Challenges to care
As a midwife having spent time in both war and natural disaster-stricken areas, dysfunctional health systems are of great concern. These facilities, often in war-torn parts of the world are unstable and uncertain and put patients at risk. Here is just a sampling of what patients in these areas could experience:
- Regular airstrikes that make regular visits from healthcare professionals irregular
- Restricted stays in the hospital of only 24 hours or less after birth (given resource constraints)
- Checkpoints, turning trips that should take minutes into hours-long journeys. (Some women are forced to endure labour or childbirth at a checkpoint.)
Systemic factors, such as cultural norms or values, may also play a significant role in some areas. Women may have limited access to new ideas, research and education, for various primary or secondary reasons, which can include:
- Lack of education, awareness and understanding regarding the importance of postnatal care, such as breastfeeding education or regular home visits. Precautions such as washing hands before and after breastfeeding, or avoiding coughing or sneezing on the baby are easy to follow once awareness and understanding is in place.
- Lack of even brief sun exposure to produce vitamin D due to cultural norms. In some cultures, women are often not allowed to leave the house postnatally for six weeks. In other cultures, clothing can prevent the sun exposure needed to produce vitamin D. This can lead to vitamin deficiency as well as depression, as there’s an association between low vitamin D status and increased risk of depression during and after pregnancy.
- Taboos surrounding mental health assistance. This can lead to a lack of intervention, putting a mother and her child at unnecessary risk.
"Mothers and expectant mothers have the same needs, desires and necessity for quality care wherever they live."
”The way forward
Work is already underway as international organizations, academic institutions, pharmaceutical companies, NGOs, hospitals, healthcare providers and governments everywhere play important roles in shaping this improved health agenda for mothers. For instance, the United Nations Population Fund (UNFPA) assisted 1M safe deliveries in humanitarian and fragile settings in 2018. Also, 15,000 midwives were trained and educated by UNFPA in 2018.
Still, there is much work to be done and the public can also help in these efforts. Here are a few ways that the general public can help the plight facing expectant mothers:
- Donations. Even the smallest donation to leading international and local organizations can go a long way to reaching as many mothers as possible. At the international level, organizations such as CARE International, GSK, Save the Children and others work to ensure women affected by conflict or disasters have access to the health care they need. Look for organizations dedicated to tackling maternal and new-born health issues in vulnerable populations.
Local organizations can also be a great way to contribute. For instance, in my local community, ‘Pregnancy Choice’ in Tauranga, New Zealand, does much to support to-be-mom’s with resources. - Volunteer. For those trained as midwives or health personnel, there is a great need for and shortage of volunteers on the frontlines. Volunteer organizations provide the necessary assistance to place midwives in locations most needed.
It is never too late to lend a hand. I was in my 50s when I studied to become a midwife and became a volunteer in my 60s in some of the world’s most unstable and poorest conditions to help women and babies survive childbirth. Take that first step to contact a volunteer agency to learn what it will take to contribute your time. - Create. The global tech ecosystem has stepped up to design technology innovative solutions to tackle COVID-19 and that same sense of urgency and collaboration can be applied to maternal care in vulnerable areas.
Maternal care is so much more than just the safe delivery of mom and baby. Pre- and post-natal care, including education and awareness of breastfeeding education and mental health support are as critical. In these areas, technology and innovative solutions can help bridge existing gaps to support women in such remote areas. - Care. Your kindness, respect, and advocacy – no matter how big or small the action – is key to recognize and support health personnel to ensure that women and babies survive in these most marginalized areas. The World Health Assembly has designated 2020 the International Year of the Nurse and the Midwife to get more focus and support for health workers. One place to start is with The World Health Organization toolkit which contains ideas, tools and resources to aid initiatives supporting nursing and midwifery activities.
- Share. Medical professionals working on the cutting edge of COVID-19 should share and make available the research and development on the implications and treatment of COVID-19 with those helping pregnant women in vulnerable areas.
Also, sharing evidence-based information on the coronavirus with pregnant women is paramount in these uncertain times, to put pregnant mothers minds at ease regarding the risks they do or don’t face during events such as birth or breastfeeding. Finding ways to share valuable information through pamphlets in a local language will not only counteract unnecessary anxiety, but can contribute to a healthier pregnancy for many.
Mothers and expectant mothers have the same needs, desires and necessity for quality care wherever they live. The women in developing and war-stricken countries have the need to be appreciated, cared for, nurtured, supported and loved. As mothers, they have the right to a health care system and policies that will ensure safety, health and protection for them and their babies. They also have the right to enjoy their pregnancies, something that life-threatening situations and priorities around survival, make difficult.
Let’s not have these current circumstances shape the way forward for mother and child. Childbirth coupled with the world’s most complex crises, ask for every bit of strength, bravery and endurance – with undoubtedly skilled support. As outlined above, all can help. Every aspect of caring is a positive step towards life and coping in difficult circumstances.
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