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‘Catastrophic’ healthcare costs putting poorest pregnant women at risk

07 June 2019

Lives are being endangered by the cost of maternal care, UNICEF warns


A Venezuelan mother holds her newborn baby at a maternity hospital in Brazil. Expectant Venezuelan mothers are leaving their country because of a lack of prenatal care and medicines, and giving birth across the border in Brazil

A Venezuelan mother holds her newborn baby at a maternity hospital in Brazil. Expectant Venezuelan mothers are leaving their country because of a lack...

THE lives of the world’s poorest pregnant women and their babies are being put at risk because of “catastrophically” prohibitive healthcare costs before, during, and after childbirth, UNICEF has warned.

In its latest report, Healthy Mothers, Healthy Babies: Taking stock of maternal health, published on Monday, the UN children’s agency states that the number of women and girls who die each year because of pregnancy and childbirth-related issues decreased by 43 per cent from 532,000 in 1990, to 303,000 in 2015.

Yet more than 800 women a day were still dying from pregnancy-related complications; and the mothers who did survive childbirth were left with injuries or other debilitating outcomes because of a lack of proper maternity care. It estimates that there are at least 7000 stillbirths a day; half these babies were alive when labour began. A further 7000 babies die in the first month of life.

“Pregnancy is a key opportunity to reach women with essential services for their own health and that of their unborn child. Yet the costs of antenatal care and delivery services, coupled with other challenges, can deter pregnant women from seeking much-needed care, endangering the lives of mothers and their babies.”

More than five million families a year across Africa, Asia, Latin America, and the Caribbean spent more 40 per cent of household expenses on maternal health services, UNICEF found, on the basis of data for the period 2013 to 2018. About three million of these households were in Asia (almost two-thirds), 1.9 million in Africa.

The executive director of UNICEF, Henrietta Fore, said: “For far too many families, the sheer costs of childbirth can be catastrophic. If a family cannot afford these costs, the consequences can even be fatal. When families cut corners to reduce maternal health-care costs, both mothers and their babies suffer.”

Adolescent mothers are particularly vulnerable to poor health care, UNICEF reports. Maternal conditions were the top cause of mortality among girls aged 15 to 19, it says. “Because adolescent girls are still growing themselves, they are at greater risk of complications if they become pregnant; those aged ten to 14 are particularly at risk of poor obstetrical outcomes.”

The highest rates of early childbearing occur in sub-Saharan countries: 17 countries had adolescent birth rates at, or exceeding, 120 births per 1000 girls aged 15 to 19, in 2018. In Cameroon, Chad, and the Gambia, more than 60 per cent of girls who married before turning 15 have three or more children by the ages of 20-24, compared with fewer than ten per cent of women at the same age who married as adults.

Universal skilled birth attendance by 2030 is one of the UN Sustainable Development Goals (SDG) (News, 2 October 2015).

“Ensuring that every delivery is attended by a skilled provider — generally speaking, a doctor, nurse or midwife — is one strategy for reducing maternal and new-born morbidity and mortality,” the report states. But there were “wide gaps” in provision within countries.

“Although global coverage of skilled birth attendance has shown impressive gains in recent years, wide gaps in coverage across countries persist. The lowest coverage levels tend to be in the poorest countries where maternal mortality levels are highest.”

In South Asia, for example, three times as many wealthy women received four or more antenatal care visits than women from poorer families.

A caesarean section was also a life-saving intervention and should be part of comprehensive emergency obstetric care, UNICEF reports. C-section deliveries almost doubled to 30 million in all regions of the world from 2000 to 2015.

The prevalence of C-sections in Latin America and the Caribbean (44 per cent of all births in 2015) was more than ten times higher than in West and Central Africa. In the latter region, wealthy women were more than twice as likely than poorer women to give birth at a facility, UNICEF reports.

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