‘Catastrophic’ healthcare costs put mothers and newborns at risk

In a new report highlighting how few of the world’s poorest pregnant women have a doctor, nurse of midwife at their side when they need them most, the UN Children’s Fund said that more than 800 women die every day from complications, while many more mothers live with “debilitating” outcomes.

At least 7,000 stillbirths also occur every day - half being babies who were alive when labour began - while 7,000 babies also die in the first month of life, UNICEF 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 - UNICEF chief Henrietta Fore

“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”, said UNICEF Executive Director Henrietta Fore. “When families cut corners to reduce maternal health care costs, both mothers and their babies suffer.”

More than five million families across Africa, Asia, Latin America and the Caribbean spend at least 40 per cent of their non-food household expenses for the entire year just on maternal health services, according to UNICEF.

Approximately 1.9 million of these families are in Africa, while around three million are in Asia. Compared with most rich countries, where a skilled birth attendant is present at almost all deliveries, the tally drops significantly in least developed countries, the UNICEF research shows.

These States include Somalia (9.4 per cent) and South Sudan (19.4 per cent), along with Madagascar (44.3 per cent), Papua New Guinea (53 per cent), Afghanistan (58.8 per cent) and Myanmar (60.2 per cent), based on 2013-2018 data.

Within countries, the gap is also stark between those who can afford help and those that that cannot. In South Asia, for example, three times as many wealthy women receive four or more antenatal care visits than women from poorer families.

When it comes to women giving birth at a facility, the gap between the poorest and the richest women is more than double in West and Central Africa, according to UNICEF.

'Wide gaps' persist

“Although global coverage of skilled birth attendance has shown impressive gains in recent years, wide gaps in coverage across countries persist,” it said in a statement.

According to UNICEF’s analysis, from 2010 to 2017, health personnel increased in many countries. However, this increase was “minimal” in the world’s developing countries, where maternal and neonatal mortality levels have been highest.

For example, from 2010 to 2017, coverage increased from four to five health workers per 10,000 people in Mozambique, and from three to nine in Ethiopia. In contrast, Norway saw that number increase from 213 to 228 health personnel over the same period.

“Doctors, nurses and midwives play a critical role in saving mothers, yet millions of births occur every year without a skilled attendant,” UNICEF said. Focusing on uneven access to emergency care across the world, the UN agency underscored the lifesaving value of a caesarean section, or C-section.

Globally, around 30 million C-sections were carried out in 2015 – almost double the number in 2000, but their prevalence in Latin America and the Caribbean - in 44 per cent of all births in 2015 - was more than 10 times higher than in West and Central Africa.

“This low percentage of C-sections in West and Central Africa is alarming, suggesting a dire lack of access to this potentially lifesaving intervention,” UNICEF warned. Globally, the report also notes that pregnancy-related complications are the number one cause of death among girls between 15 and 19 years old.

Child brides at greater risk

This is partly because adolescent girls are still growing and are at great risk of complications if they become pregnant. Yet the report finds that child brides are less likely to receive proper medical care while pregnant or to deliver in a health facility, compared to women who married as adults.

In Cameroon, Chad and the Gambia, more than 60 per cent of girls now aged 20-24 who married before turning 15 have three or more children, compared to less than 10 per cent of women at the same age who married as adults.

Despite its concerns, the UN agency maintains that overall, the number of women and girls who die each year from issues related to pregnancy and childbirth has dropped more than 40 per cent in the past 20 years, from 532,000 in 1990, to 303,000 in 2015.

The UN agency also expressed hope that the inclusion of a skilled healthworker in the Sustainable Development Goal (SDG) 2030 Agenda would spur efforts to reach universal health coverage and reduce maternal and newborn deaths.

In an effort to protect the world’s newborns, UNICEF’s Every Child ALIVE campaign calls for greater investment in health systems, recruitment and training of doctors, nurses and midwives; clean and functional health facilities with water, soap and electricity for every mother and baby, life-saving drugs and equipment during delivery, and for the empowering of adolescent girls and families to demand quality care.

UNICEF/Jan Zammit