COVID-19 leaves maternal healthcare in a coma

THE global COVID-19 pandemic has had devastating effects on the delivery of sexual reproductive health services and has rolled back several years of progress in improving maternal health. Zimbabwe is still among countries with high maternal mortality rate and research has proved that delays and even lack of access to proper healthcare is a major catalyst to the high mortality rate.

“The pandemic has seen critical resources diverted to containing the virus at the expense of sexual reproductive health services,” Fungisayi Dube of the Citizens Health Watch said.

“Maternal deaths, infant mortality rates, still births and unsafe home deliveries were on the rise with women failing to access contraception and maternal health care services.”

Critical maternal health services, like antenatal care (ANC) were hugely disrupted with indications that visits declined by 45% in 2020 (April-July) compared to the same period last year.

ANC is a means to identify highrisk pregnancies and educate women so that they experience healthier pregnancies.

Most council-owned polyclinics were largely shut during the peak of the pandemic, forcing women to seek help from community birth attendants like Mbare’s Mbuya Gwena (Esther Zinyoro), who was inundated with several women seeking maternal care at her residence.

“I could not just watch these women suffer and I had to do something. Many came to Edith Opperman, but it was closed and because I stayed close to them, would send them to my house so that I would assist them,” Mbuya Gwena said.

She hit the news last year when she assisted over 400 women to give birth. But critics lambasted the government for failing to prioritise sexual reproductive health through proper funding. “Citizens Health Watch implores the government to put in place urgent measures to reinforce provision of sexual reproductive health services.

“SRHR [sexual health reproductive rights] must become an integral part of COVID-19 response planning, in particular the provision of free maternal health care,” Dube said.

The implementation of this policy has been inconsistent, with some charging fees, while many said they had no back-up funds for the policy.

“A government must commit to securing funding for the provision of free sexual reproductive health services.

“Government should desist from deceptive policies which are never accompanied by political will to implement them,” she said.

Stakeholders have often raised concerns that there is no genuine political will and energy towards developing sustainable policies.

Most women did not have access to sexual reproductive health services which include contraception, maternal health due to lockdown measures which curtailed movement.

A local study (still under review for the journal BMC Pregnancy and childbirth) carried out at Mpilo Central Hospital noted that travel restrictions and emergency regulations have had negative impacts on maternity services, including staff shortages, resource stock-outs, and closure of antenatal clinics.

“Estimates of the indirect impact of COVID-19 on maternal and perinatal mortality expect it to be considerable, but little data is yet available,” noted the authors.

This study compared maternal and perinatal morbidity and maternal mortality before and after the lockdown period and how it was implemented.

Some of the results indicated that between January and March, and April to June 2020, the average monthly deliveries fell from 747 to 681 and Caesarean section rates from 29,8% to 26,6%.

Women with un-booked pregnancies presenting in labour almost doubled from 4,4% to 8%.

There was no substantial change, however, in maternal mortality or severe maternal morbidity (post-partum haemorrhage, uterine rupture, and severe preeclampsia/eclampsia), stillbirth rates, or special care baby unit admission.

“There was a small increase in early neonatal death from an average of 18,7 to 24 deaths per month.”

The study recommended that maternal and perinatal outcomes must continue to be monitored to assess the impact of COVID-19 and lockdown measures as the epidemic in Zimbabwe unfolds.

However, on a positive note, despite the vulnerability of the healthcare system, healthcare workers of maternity units displayed resilience, providing care in the most difficult circumstances.