‘Let us not leave pregnant women, newborns behind’
WE ARE regrettably in the era of colliding or compounding global epidemics making the future uncertain for every generation that succeeds us. While this is a scary thought it should also be an urgent call to action.
Between October 31 and November 12, the UK is hosting the 26th UN Climate Change Conference of the Parties (COP 26). This event is arguably the last real chance that global and national leaders have to make decisions that will prevent large-scale damage to the planet and its people. As President Cyril Ramaphosa noted there is great urgency to rapidly retard the rate of global warming and deal with the effects of climate change.
Climate change and excessive heat is likely to exacerbate the already high maternal and newborn mortality especially in low and middle countries, and in sub-Saharan Africa in particular. According to the WHO, sub-Saharan Africa accounts for roughly two-thirds or 196 000 maternal deaths, with South Asia accounting for nearly onefifth or 58 000 annually. Put another way, the maternity mortality ratio in low-income countries is 462 per 100 000 live births while it is 11 per 100 00 in high income countries.
Similarly, according to Unicef, neonatal mortality is 27 per 1 000 live births in sub-Saharan Africa and 25 per 1 000 in South Asia. Put another way, a child born in sub-Saharan Africa is 10 times more likely to die in the first month of life than a child born in a high-income country, while a child born in South Asia is nine times more likely to die.
In South Africa, according to the South African Medical Research Council, the maternal mortality ratio is estimated at 134 per 100 000 live births with the neonatal mortality rate at 12 per 1 000 live births. There is evidence that these rates increased as a result of the Covid-19 pandemic in the last year.
It is clear that pregnant women and newborns are already extremely vulnerable which simply means that this situation is going to get worse due to pandemics and the impact of climate change. Unless we act now the existing inequity in mortality between the global north and the global south and the rich and the poor will only get wider. What we know is that the biology of pregnancy creates specific vulnerability to climate change. Pregnant women are more at risk for heat-related illnesses than their non-pregnant counterparts. In addition, moms exposed to extreme heat during pregnancy are at higher risk of stillbirths, preterm births and delivering low birth weight infants.
UN Habitat estimates that a staggering 1 billion people live in so-called “slums”. These people are highly vulnerable to climate changes and poor health outcomes. Among this number are pregnant women who do a variety of outdoor work and the homeless who are continuously exposed to the elements.
What is the state of readiness of South Africa to deal with climate change and what has been done in the past decade on climate change and health?
In 2011 the South African government published the National Climate Change Response White Paper which has a number of goals and objectives, including a focus on heat stress and called for heat-health action plans. Subsequently in 2014, the Ministry of Health published its National Climate
Change and Health Adaptation Plan for the period 2014 to 2019. While the Department of Environmental Affairs has published two reports on climate change in 2015 and 2017 there is little evidence that much has changed.
What’s to be done? Here are a few actions we can take now.
Develop government wide policies that increase awareness of the impact of excessive heat on pregnant women and newborns as well as strategies to mitigate its impact & support civil society organisations to hold governments accountable for implementation
Consider the use of cash transfers for indigent pregnant women to enable them to protect themselves during their pregnancy and post-partum period.
Monitor heat levels especially in poorly constructed and poorly ventilated homes
Work with employers to protect pregnant women from working in environments with excessive heat and explore the option of flexible working hours
Make health workers aware of the dangers of excessive heat and its impact on pregnant women and their newborns and share knowledge on how to mitigate the impact of heat (staying out of the sun, hydration etc).
Collaborate with other government departments to ensure availability of free and clean drinking water in strategic places to improve hydration status especially for pregnant women and children under-5 living in informal settlements and rural areas.
Improve access and quality of health and social welfare services for pregnant refugees and their newborns and for those that are homeless.
A quote from Nelson Mandela can be used to summarise what we need to do: “It is in our hands to create a better world for all who live in it”.
This quote speaks to both our responsibility as well as the importance of equity. Let us not leave pregnant women and newborns behind – especially the poor!