COVID-19 IN PREGNANCY: ENGENDERING RURAL MATERNAL HEALTH IN SUB-SAHARAN AFRICA

The pervasive effects of COVID-19 in the global community has received wide-ranging national and international responses.Of prominence, international organizations such as WHO and United Nation as well as various state governments have made considerable efforts and mobilized all round resources to safeguard health capacities. However, there is need to pay apt attention to a larger vulnerable group: pregnant women, newborns and mothers.

Efforts at engendering maternal and reproductive health from time immemorial in African communities have generated intense attention and discourse among scholars. Maternal mortality also remains a major public health challenge in developing countries especially in sub-Saharan Africa. As captured by WHO data, sub-Saharan Africans suffer from the highest maternal mortality ration-533 maternal deaths per 100,000 live births or 200,000 maternal deaths in a year. This constitute over two-thirds (68 percent) of all maternal deaths per year globally. A major argument attributed to high incidences of maternal mortality in sub-Saharan Africa is the inadequate access to quality maternal healthcare services either during pregnancy, delivery or after birth.

In spite the global commitment to helping end preventable maternal mortality, the poor state of healthcare in Africa is alarming. The resultant effect is that pregnant and postpartum women seems to be at a particularly high risk of COVID-19complications. This is because four-fifths number of pregnant women in the region do not have access to adequate maternity services during pregnancy, childbirth and six weeks after birth.

No doubt, health systems and international organization around the globe ramp up significant measures to contain the ongoing pandemic. Such government regulations such as lockdown and curfew may impede access to maternal welfare services. Points in view include:

  • Limited access to reproductive and maternal healthcare: As resources are committed to containing the spread of COVID-19, the chances of a deteriorating state of maternal healthcare become evident. Initially, this might follow a short-term pattern and sporadically increase in the long run. In addition, difficulties are encountered in determining the extent of higher-risk pregnancies as prenatal checkups become irregular, and pregnant women are reluctant to visit clinics due to the fear of contracting the virus.
  • Subsequent increase in the prices of healthcare: Socio-economic inequalities in sub-Saharan Africa orchestrated by extreme poverty coupled with the outbreak of the global pandemic led to the hike in the price of healthcare items. Prices of such items such as facemask, baby wipes, hand sanitizers, food, toiletries to mention but a few have drastically increased such that disadvantaged pregnant women and nursing mothers cannot buy them. To illustrate, in Lagos, Nigeria, several pregnant women have been found to be visible on Lagos markets in an attempt to wanting a favourable price of commodities in this trying moment. This has made them more vulnerable to the menace of COVID-19.
  • Lack of conducive and healthy environment: A cleaner environment is next to a healthier nation. While the government has proposed that social distancing is key to preventing the spread of the ongoing pandemic, efforts to achieve this goal in shanties and slums where the state of health is not appealing pose greater challenges to pregnant women, newborns and mothers in this community.Failure to comply with the practice of lockdown and social distancing coupled with food insecurity that characterized the region make more pregnant women are vulnerable to contracting the virus as good hygienic practices and  the culture of cleanliness is virtually absent.
  • Struggling health system: The deteriorating healthcare system that characterized sub-Saharan Africa in the eve of the outbreak of COVID-19 is worrisome. For pregnant women, access to adequate maternal aid, counselling, vital information on nutritional value, formular-fed infant and sexual relations during pregnancy is limited.

It is high time African government learnt from history on how pregnancy has been a risk factor to increased illness and mortality in the past pandemic situations.The outbreak of  1918 flu pandemic, Ebola and Lassa Fever are worthy of mention. Mechanical and hormonal and immunologic alteration during pregnancy, with a shift away from cell-mediated immunity towards humoral immunity make pregnant women to be more susceptible to the threat of viral pathogens.In 2014, WHO informed of less compliance to treatment protocols as well as decline in maternal and newborn healthcare use. Similarly, Lassa fever was reported to be especially severe late in pregnancy, with maternal death and /or fetal loss occurring in more than 80% of cases during the third trimester.

It is remorseful that a few pregnancy-related COVID-19 mortality have been recorded. This calls for drastic measures to be put in place to prevent such incidences especially in rural regions. Containing the menace of COVID-19 in sub-Saharan Africa requires a unique and balanced multi-facet approach to enhancing maternal health. The underlisted are vital.

  • An educative awareness on the virus through the media is essential. In rural communities, house-to-house dissemination of messages to pregnant women should be well harnessed through the native language and local agencies such as traditional rulers.
  • Free and adequate screening of pregnant women, new borns and mothers. They should be considered for receipt of free anti-COVID-19 medication and treatment.
  • Taking into cognizance the high risk of COVID-19 on maternal health, an integrative (traditional and orthodox) approach to the reproductive health of women is essential.
  • Poverty has eaten deep into the normal psych of disadvantaged pregnant women and nursing mothers, hence, good governance anchored on grassroot participation, engendered reproductive health as well as adequate healthcare and social amenities should be accelerated.
  • Training and compensation of frontline health workers is ultimate. COVID-19 phenomenon is a call for patriotism and professionalism. Health workers should uphold the dignity of their profession as well develop positive relations attitude towards pregnant women in this trying moment.
  • Non-governmental organizations, private individuals, philanthropists and corporate bodies should fill the gap by reaching out to pregnant women in rural communities with their token of love.
  • Government should fund research, advocacy, and practice on pandemic and maternal health. It is high time scholars rose to the call of historical scholarship to widen the horizon of knowledge and profer lasting solutions to the impending doom.
  • African government as well as The Centers for Disease Control and Prevention should learn from history. In time past, a consortium of international organisations including the WHO, UNICEF and Save the Children made recommendations and guidelines detailing appropriate policy, supervision and monitoring and evaluation which had positive and meaningful impact on maternal and newborn health. Navigating through this historical past will serve as searchlight to the present pandemic while preventing such future occurrences.

Tolulope Fadeyi

Founder, AbiyeAfrica | Research Associate | Doctoral Candidate | African History Department of History | University of Basel tolulopee.fadeyi@unibas.ch

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