Midwife Emily Owino cuts the umbilical cord of a newborn baby girl in Kenya with a razor blade
Photo:Brian Inganga / AP
It is shortly before midnight when Brian Inganga gets the call. "You have to hurry up," the midwife tells him. The 31-year-old photographer immediately takes a motorcycle taxi to Kibera, a slum in Nairobi, the capital of Kenya. Inganga is afraid, because not only is the slum "dark and dangerous," it is also curfew, and "the police are very aggressive at night," he says.
The midwife picks him up on a street corner and leads him through narrow streets to her little hut. Veronica Atieno, 23, lies there in a tiny room. She is in severe labor.
On the following hours of May 29, Inganga will photograph the young mother giving birth to her daughter Shaniz Joy Juma. Without doctors and medication, the only aids a wooden spoon to bite on and a midwife's brew made of herbs to relieve pain. "It was a shocking experience," says the photographer on the phone as he tells the story of his photos. "Our women cannot go to the hospital for childbirth, they kneel on dirty floors and are terrified."
The birth took several hours. Veronica Atieno bites a wooden spoon to better endure the pain
Photo:Brian Inganga / AP
Brian Inganga wanted to document a birth like this because he is worried. He grew up in Kibera himself and knows what life in the slum means. "Poverty and danger," he says. "And now everything has become even more difficult. The corona crisis is a threat to women. Many people become pregnant unintentionally because there are hardly any contraceptives available or they are abused at a young age. And women giving birth are extremely at risk and are on their own."
Kenya had one of the highest maternal mortality rates in the world even before the pandemic. Although hardly any data for 2020 are available so far, experts and aid organizations assume that the number of women and babies who die in childbirth or shortly afterwards will increase significantly - not only in Kenya, but worldwide.
A study by Johns Hopkins University, based on model calculations for 118 countries, predicts in the worst case more than one million additional deaths of children and 56,700 mothers in 2020 - due to the pandemic. "Exact numbers are hard to come by right now," says Rebekka Frick, 43, health expert from Save the Children. "The full extent of the pandemic on maternal and infant mortality rates will not reveal itself for a few years."
"We are more than concerned. This is partly due to reports we have received from countries such as Kenya and India, but also to our knowledge of developments that have triggered other epidemics."
Rebekka Frick, Save the Children
In the first published study on the impact of a lockdown on births, international scientists analyzed data from nine hospitals in Nepal: The lockdown led to a decrease in hospital births by almost half in the South Asian country. Stillbirths and newborn deaths rose 50 percent over the same period.
Similar numbers are expected for many other poor nations. "We are definitely more than concerned," says Frick. "This is partly due to reports that we receive from countries such as Kenya and Bangladesh, but also to our knowledge of developments that have triggered other epidemics."
Seven dead babies in one night
In some African countries the medical staff is already sounding the alarm. At the Central Hospital in Zimbabwe's capital Harare, seven babies died in childbirth in one night in late July. A doctor tweeted a photo of the infants lined up next to each other and wrapped in towels.
In South Africa, doctors told the BBC that the maternity ward at Dora Nginza Hospital in Port Elizabeth was completely overwhelmed, "several mothers and babies died" and the staff were "deeply traumatized".
The deaths in both countries are attributed, among other things, to the severe understaffing. Most of the medical staff must primarily treat Covid 19 patients or are infected with Corona themselves. Others strike out of fear for their health: there is a lack of protective clothing such as masks and gloves. However, disinfectants and medicines have also become scarce due to delivery bottlenecks. Pregnant women now often wait days for urgent operations, and in emergencies or giving birth, they can hardly be helped.
"The consequences of the pandemic are catastrophic," says Emma Ingaiza. The 32-year-old works for the non-governmental organization (NGO) Shining hope for Communities in Kenya and has been in constant use since the beginning of the corona crisis to help people in emergency situations, including many pregnant women.
Ingaiza have also received reports of an unusually high number of dead infants and deceased mothers in recent weeks. "Everyone is panicking about the coronavirus," she says. "All protective measures and almost the entire capacity of the remaining medical staff are geared towards Covid-19. Pregnant women, mothers and babies suffer greatly from it."
In Kenya, she reports, some medical facilities, in which up to 30 children were born per night during non-Corona times, had to close due to understaffing. Women who went into labor in the evening would not dare to leave their homes. The police enforced the night curfew, a preventive measure that has been intended to curb the spread of the corona virus since mid-March, sometimes brutally. Several people were killed by the police because they were outside at night. "Including a man who wanted to drive his pregnant wife to the hospital," says Brian Inganga. "Word gets around quickly."
A baby shortly after a home birth in Mexico City on May 25: Mexico has seen an increase in maternal mortality since the coronavirus spread
Photo: Gustavo Graf Maldonado / REUTERSThe result is often home births, in the best case at least a midwife is present. But even the midwives are now overwhelmed. "Sometimes they have three women with severe labor with them and only one pair of gloves," says photographer Inganga, who has been in direct contact with many midwives in Nairobi for weeks. "Then what should you do?"
Midwives in Germany and other rich countries have observed that many expectant mothers have obviously benefited from the contact restrictions and thus the need to do nothing during the pandemic. In one study, the decline in premature births is attributed, among other things, to the reduction in stress.
In many other countries around the world, especially in poor nations, where there was often a lack of life-saving medical care for mother and child even before the corona crisis, an increase in the maternal and child mortality rate is now feared. The World Health Organization (WHO) speaks of maternal mortality if a woman dies during pregnancy or up to 42 days after giving birth. Newborn mortality refers to the number of infant deaths in the first 28 days of their lives.
For many aid organizations and scientists, figures available from past and in parts comparable epidemics are an important indicator for assessing the current situation. The West African Office of the United Nations Population Fund (UNFPA) has issued a guide based on the lessons learned from the epidemics that have emerged since 2003. For example, during the Ebola epidemic that raged in Guinea, Sierra Leone and Liberia between 2013 and 2016, the restriction of medical care led to a sharp increase in the maternal mortality rate.
UNFPA therefore recommends that the newly established Covid 19 crisis teams in many countries focus more on the issue of women's health.
Mothers and babies become infected in the hospital
Another problem is ensuring the health care that usually takes place around a birth. "In many countries, women no longer come to hospitals out of fear of Corona," says Rebekka Frick from Save the Children. "They hear that many people die there and want to protect themselves and their babies."
In Mexico, too, this fear means that pregnant women go to hospital very late if there are complications, observes doctor Hilda Argüello Avendaño from the Observatorio de Mortalidad Materna, a civil society observatory for maternal mortality. Only recently, eight children, including four newborns, were infected with corona in a hospital in Oaxaca.
"In Mexico, the pandemic has turned into the leading cause of maternal mortality," says Hilda Argüello Avendaño. Compared to the same period last year, the maternal mortality rate has increased by more than 25 percent: By early August, 97 women who had been infected with the virus had died during pregnancy or shortly after giving birth.
The 24-year-old Karla Lopez Rangel gives birth to her child in Mexico City at the end of May - with the help of a midwife and her husband
Photo:Gustavo Count Maldonado / REUTERS
Pre-existing conditions such as obesity, diabetes and high blood pressure had contributed to the severe course of the disease in about half of the deaths. The pandemic reveals the social inequality in the country: According to the doctor, expectant mothers who are not covered and dependent on free state health care have a particularly high risk of dying - also because they often get poorer or too late help.
Failure to visit a midwife or the village health center, doctor or hospital does not only have direct effects on the birth. "Preventive examinations, vaccinations and aftercare are often completely eliminated," says Rebekka Frick. "That will have devastating consequences and put a lasting burden on health systems."
Whether measles, tuberculosis or malaria, the fight against life-threatening diseases threatens to be wiped out worldwide by the corona crisis. Doctors and NGOs fear that millions will die in the coming months and years not from the coronavirus, but from the consequences, or from other, actually treatable diseases - among other things, because the necessary vaccinations will not be available.
Great progress in the past 20 years - up to the pandemic
This is particularly tragic because many countries have made great strides in reducing mortality rates over the past few decades: since 2000, child deaths have fallen by a good 40 percent and maternal deaths by more than a third. According to the UN, reducing maternal and child mortality is an essential point in order to achieve the third goal of the 2030 Agenda for Sustainable Development (SDGs): "Health and well-being for all."
For this, however, much greater attention would have to be paid to the health of mothers and babies worldwide, also because governments do not neglect basic medical care - in addition to the treatment of corona patients.
Shaniz Joy Juma, the baby from Kenya, a good month after his birth with his father
Photo:Brian Inganga / AP
In countries like Mexico there are calls for home births to be better regulated and financed by the state - until now women in Mexico have had to pay midwives themselves. Some aid organizations also consider mobile emergency teams to be useful, which pregnant women can visit even in remote communities in order to provide them with medication and information. Or, if necessary, would enable them to be transported to a hospital.
The photographer Brian Inganga wants to follow the little girl, whose birth he documented, with his camera in the coming years. Shaniz Joy Juma is now two and a half months old. "I'd like to take pictures of her when she graduated from school," says Inganga. "I hope she doesn't get sick."
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