The Pre­ventable Trauma of COVID Child­birth

Business a.m. - - FRONT PAGE - MARY FITZGER­ALD Fitzger­ald is Ed­i­tor in Chief of openDemoc­racy. Copy­right: Project Syn­di­cate, 2020. www.project-syn­di­cate.org

LON­DON – “The baby is dead. We can’t as­sist you here.” By the time she heard these dev­as­tat­ing words, the preg­nant Yas­melis Casanova had en­dured a long and painful jour­ney, pass­ing through mul­ti­ple COVID-19 check­points, to the hos­pi­tal in Cara­cas, Venezuela. She bled for hours with­out treat­ment.

LON­DON – “The baby is dead. We can’t as­sist you here.” By the time she heard these dev­as­tat­ing words, the preg­nant Yas­melis Casanova had en­dured a long and painful jour­ney, pass­ing through mul­ti­ple COVID-19 check­points, to the hos­pi­tal in Cara­cas, Venezuela. She bled for hours with­out treat­ment. When doc­tors at a sec­ond hos­pi­tal fi­nally op­er­ated on her, they re­moved her ovaries with­out her prior con­sent. Then, she spent 20 days there almost en­tirely alone; due to COVID-19 re­stric­tions, visits were banned.

Venezuela’s health-care in­fra­struc­ture was crum­bling well be­fore the pan­demic, but the COVID-19 cri­sis has pushed it to the point of col­lapse. Many women ex­pe­ri­enc­ing ob­stet­ric emer­gen­cies now strug­gle to reach hos­pi­tals, let alone gain ac­cess to ad­e­quate care. Yet such fail­ures can be seen far be­yond Venezuela, in rich and poor coun­tries alike.

Last month openDemoc­racy re­leased the re­sults of a global in­ves­ti­ga­tion into the treat­ment of women in child­birth dur­ing the COVID-19 pan­demic. Across 45 coun­tries – from Canada to Cameroon, from the United King­dom to Ecuador – we found what doc­tors and lawyers de­scribe as “shock­ing” and “un­nec­es­sary” breaches of laws and World Health Or­ga­ni­za­tion guide­lines in­tended to pro­tect women and ba­bies dur­ing the pan­demic.

The WHO’s spe­cific COVID-19 guide­lines af­firm, for ex­am­ple, that women should be ac­com­pa­nied by a per­son of their choice while giv­ing birth. Yet, across Eura­sia and Latin Amer­ica – in­clud­ing in at least 15 Euro­pean coun­tries – women have been forced to give birth with­out com­pan­ions.

Like­wise, the WHO as­serts that pro­ce­dures like C-sec­tions should be per­formed only when they are med­i­cally nec­es­sary or have the woman’s con­sent. Yet in 11 coun­tries, women re­ported that they didn’t con­sent to C-sec­tions, in­duc­tions, and epi­siotomies (the cut­ting of a woman’s vagina) that were per­formed on them, or said that they did not be­lieve these pro­ce­dures were med­i­cally nec­es­sary.

WHO guide­lines also dic­tate that women re­ceive breast­feed­ing sup­port and the op­por­tu­nity for skin-toskin con­tact with new­borns. Yet moth­ers have been sep­a­rated from new­borns in at least 15 coun­tries – in­clud­ing at least six Euro­pean coun­tries – and pre­vented from breast­feed­ing in at least seven, even though there is no con­clu­sive ev­i­dence that COVID-19 can be trans­mit­ted through breast milk.

Doc­tors and health ex­perts agree: none of this is nec­es­sary to pre­vent the spread of COVID-19.

Like­wise, there have been mul­ti­ple re­ports of preg­nancy deaths in Africa, after trans­port and other lock­down re­stric­tions pre­vented women from reach­ing hos­pi­tals. Many women in de­vel­op­ing coun­tries have been forced to give birth in un­san­i­tary and un­safe con­di­tions. Ex­perts now warn that over the course of just six months, COVID-19 re­stric­tions and health-ser­vice dis­rup­tions could cause up to 56,700 ad­di­tional ma­ter­nal deaths in low- and mid­dle-in­come coun­tries.

If this is not enough to ex­pose the flaws in cur­rent COVID-19-preven­tion mea­sures, con­sider how un­evenly they are im­ple­mented (and lifted). In some parts of Eng­land, women can now take their part­ners to the pub, but not to an­te­na­tal ap­point­ments.

This re­flects a long his­tory of the “post­code lot­tery” dic­tat­ing ac­cess to health care and other ser­vices, from in vitro fer­til­iza­tion clin­ics to do­mes­tic vi­o­lence shel­ters. And it fits a wider global pat­tern of down­grad­ing women’s rights and needs, in­clud­ing dur­ing child­birth. Just last year, a WHO-led study re­ported that 42% of the women in­ter­viewed by re­searchers in Ghana, Guinea, Myan­mar, and Nige­ria said they had ex­pe­ri­enced phys­i­cal or ver­bal abuse, stigma, or dis­crim­i­na­tion in health fa­cil­i­ties dur­ing child­birth.

In Latin Amer­ica, sev­eral coun­tries – in­clud­ing Ar­gentina, Ecuador, Mex­ico, Uruguay, and Venezuela – have passed laws against the per­for­mance of med­i­cal pro­ce­dures, such as C-sec­tions, with­out in­formed con­sent. But they are very rarely en­forced, and ad­vo­cates re­port that au­thor­i­ties and med­i­cal staff nor­mal­ize such ob­stet­ric vi­o­lence.

In fact, be­fore the pan­demic, 40% of ba­bies across Latin Amer­ica were al­ready be­ing de­liv­ered by C-sec­tion, though this method poses higher risks for mother and baby. The WHO rec­om­mends a rate of around 15%, em­pha­siz­ing that C-sec­tions should be car­ried out only when med­i­cally jus­ti­fied.

Fur­ther­more, most African coun­tries were al­ready off track to meet their tar­gets for re­duc­ing ma­ter­nal and in­fant deaths by 2030, part of the United Na­tions Sus­tain­able De­vel­op­ment Goals. As Jesca Nsungwa Sabi­iti, Uganda’s ma­ter­nal and child health com­mis­sioner, has noted, the pan­demic is likely to de­lay achieve­ment of the tar­gets even fur­ther.

But just as the COVID-19 cri­sis can im­pede progress, it can also spur change, by forc­ing gov­ern­ments and civil so­ci­ety to re­think how our health sys­tems, economies, and so­ci­eties are or­ga­nized. So far, dis­cus­sions – es­pe­cially among pol­i­cy­mak­ers – have tended to be nar­row, fo­cused on short­term so­lu­tions. If we are to build the “equitable, re­silient, and sus­tain­able” post-COVID world that many lead­ers ad­vo­cate, we must em­brace a much more am­bi­tious vi­sion of what pub­lic health re­ally means.

For ex­am­ple, laws pro­tect­ing the vul­ner­a­ble need to be en­acted and en­forced. Health bod­ies and other agen­cies must in­ves­ti­gate vi­o­la­tions and hold med­i­cal providers ac­count­able. And gov­ern­ments and donors must al­lo­cate far more re­sources for ad­vo­cacy in prob­lem­atic ar­eas such as ma­ter­nal health, and for im­ple­ment­ing a rights­based ap­proach to med­i­cal train­ing and ser­vice pro­vi­sion across the board.

The is­sue ex­tends far be­yond di­rect med­i­cal care. To­day, women can be im­pris­oned for hav­ing mis­car­riages (as in El Sal­vador) and de­tained for non­pay­ment of hos­pi­tal bills after child­birth (as in Kenya). Struc­tural in­equal­ity and dis­crim­i­na­tion based on gen­der, race, class, dis­abil­ity, and more still shapes ev­ery as­pect of our lives, in rich and poor economies alike. All of these fail­ures un­der­mine pub­lic health.

Far too many women have felt alone, scared, and trau­ma­tized while giv­ing birth dur­ing the pan­demic. In openDemoc­racy’s in­ves­ti­ga­tion, one woman in Italy ex­pressed her hope that pol­i­cy­mak­ers and med­i­cal providers would learn from her suf­fer­ing, and the suf­fer­ing of those like her, so that other women wouldn’t have to en­dure what she did. We owe it to these women to en­sure that they do.

openDemoc­racy is con­tin­u­ing to track rights vi­o­la­tions of women in child­birth glob­ally. See the full map and sub­mit ev­i­dence here.

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