Health and Healthcare Systems

COVID-19 may have ushered in a remote work revolution in maternal and child health

An indigenous Mayan woman sits in a hammock as she carries her newborn baby at the rural hospital of the Mexican Social Security Institute, where the hospital changed regular hospital beds to hammocks as part of the "Intercultural Action in Health" programme to integrate and respect the customs and practices of indigenous Mayan patients in Hecelchakan, Campeche, Mexico August 18, 2017. Picture taken August 18, 2017. REUTERS/Victor Ruiz Garcia

An indigenous Mayan woman carries her newborn baby at the rural hospital of the Mexican Social Security Institute in Campeche, Mexico August 18, 2017. Image: REUTERS

Shirley Sylvester
Senior Medical Director for Women's Health, Johnson & Johnson
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  • Maternal mortality has dropped 38% since 2000, but that progress is not shared equally and has been hampered by COVID-19.
  • Race and location can be matters of life or death for expectant mothers.
  • Remote solutions are already being used to improve maternal healthcare for patients and providers.

The world has made remarkable progress in combating maternal mortality. From 2000 to 2017, the number of women dying during childbirth dropped by 38%. This is a milestone to celebrate — but a closer look at the data reveals that the progress has not been shared by all.

Uneven progress

Throughout 2017, a startling 810 women died every day from preventable complications related to pregnancy or childbirth — a significant proportion of them in Sub-Saharan Africa. And, while developing regions like Southern Asia saw a nearly 60% decline in the maternal mortality ratio, the United States saw an increase from 14.1 to 17.3 maternal deaths per 100,000 live births during this same time period.

Pregnancy occurring later in life, increased rates of cesarean section and high prevalence of comorbidities like hypertension, diabetes, cardiovascular disease and obesity have all contributed to this backslide.

In the US, race, ethnicity and geographic location also play a large part in the crisis. Tragically, Black and Native American women are two to three times more likely to die from pregnancy-related complications than women of other races. The Centers for Disease Control believes that more than 60% of those deaths may have been preventable.

Nurses take care of newly born babies at Kisenyi health centre in Uganda's capital Kampala April 10, 2015. Kisenyi health center in Kampala, which delivers 600 babies a month, symbolizes the shift in Uganda which has seen the country invest more money in the healthcare system to make it accessible for the poorest, Save the Children said. Child deaths in Kampala fell faster than in any other African city between 2006 and 2011 - despite a large influx of refugees from war-torn neighboring states, the charity said in a report. Picture taken April 10, 2015. To match HEALTH-CHILDREN/UGANDA   REUTERS/James Akena
Child deaths in Kampala fell faster than in any other African city between 2006 and 2011 — despite a large influx of refugees from war-torn neighboring states, the charity said in a report. Image: REUTERS

Global impact of COVID-19

The COVID-19 outbreak has also precipitated a rise in maternal and infant mortality and morbidity — a problem shared by the US and low and middle income countries.

Knock-on effects of the pandemic like illness and burnout have caused clinics and other care facilities to shut down worldwide. These challenges have been exacerbated by supply chain issues making personal protective equipment, oxygen, and donated blood harder to access, in some cases forcing clinics and other care facilities to shut down.

For many women worldwide, the closure of these clinics made existing barriers, such as restricted decision-making ability and lack of mobility and transportation, even worse. Other women have been reluctant to seek care out of concern for their safety in the hospital or clinic.

Further, a staggering 70% cancellation and postponement rate of surgical and elective procedures at the start of the pandemic created a backlog of deferred surgeries which is putting immense downstream pressure on the availability of skilled personnel and equipment. Largely unplanned and emergent surgical interventions such as cesarean sections are being referred to already overburdened facilities.

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New solutions

But where COVID-19 has created new pressures, it may also have revealed the way to a better future. In both low- and high-income countries, the pandemic has accelerated the rollout of tech-based solutions allowing providers to work remotely, safely and efficiently.

For example, the use of video conferencing can replace in-clinic screening. That can be combined with at-home monitoring of such areas as a baby’s height, weight and heart rate, as well as blood sugar levels and blood pressure. In remote locations, physicians can conference with specialists in maternal-fetal medicine, and after pregnancy, post-partum visits, lactation support and mental health care support can all be provided virtually.

E-learning and remote mentoring are also supporting health care provider education and capacity. Providers now have access to online tutorials and lectures that offer demonstrations of surgical techniques and procedures in real-time — and it is already making a difference.

Clinics in Tanzania are now using telementoring technology to complete C-section modules with a virtual checklist. Thanks to this approach, surgical site infection rates have dropped by 36% in less than six months. In Kenya, the use of teleconferencing has allowed remote participation in a C-section, including placing of clamps and sutures.

Ongoing exploration and partnership

Several partnerships are already underway to explore how we may learn from the pandemic and carry forward remote care interventions that could improve maternal and child health around the world.

The World Health Organization and the United Nations Population Fund have just launched a new initiative, Ending Preventable Maternal Mortality (EPMM), which will target areas including antenatal care, care during birth by skilled personnel, access to emergency care, postnatal care, and empowered decision making by women. The Johnson & Johnson Center for Health Worker Innovation helps improve access to mobile technology and is committed to providing resources and education to community health workers — who often serve as the only link between women and the care they need.

Results from these recently implemented programs are promising and we urge the global health community to focus its attention on collaborating to explore, innovate and standardize remote care approaches.

Together we can revolutionize how quality health care is accessed and change the trajectory of maternal and child health, not only in the US but the world over.

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