"The baby is dead. We can't help you here. " When she heard those devastating words, pregnant Yasmelis Casanova had already endured a long and painful journey, passing through multiple COVID-19 checkpoints, until she reached the hospital in Caracas, Venezuela. She bled for hours without treatment. When doctors at a second hospital finally operated on her, they removed her ovaries without her prior consent. Then, she had to stay there for 20 days, almost completely alone, since due to the restrictions due to the new coronavirus, visits were prohibited.
MORE INFORMATION
- The mistakes that kill women when giving birth
- Protection of midwives and mothers during the pandemic
- The war against maternal and infant deaths must be won
Venezuela's health infrastructure was crumbling long before the pandemic, but the Covid-19 crisis has brought it to the point of collapse. Many women in obstetric emergencies today struggle to reach hospitals, without even mentioning the battle they must fight to access adequate care. However, these failures can be seen far beyond Venezuela, in both rich and poor countries.
Last month, openDemocracy released the results of a worldwide investigation into the care provided to women in childbirth during the pandemic. In 45 countries - from Canada to Cameroon, from the United Kingdom to Ecuador - we encountered what doctors and lawyers describe as "shocking" and "unnecessary" violations of the laws and guidelines of the World Health Organization (WHO) that are designed to protect women and babies during the pandemic.
The WHO specific guidelines for covid-19 state, for example, that women must be accompanied by a person of their choice during childbirth. Yet throughout Eurasia and Latin America — including at least 15 European countries — women in labor have been forced to give birth unaccompanied.
Likewise, the WHO affirms that procedures, such as caesarean sections, should only be performed when they are medically necessary or when the woman's consent is obtained. However, in 11 countries, those affected reported that they did not give it to undergo cesarean sections, inductions, and episiotomies (cutting a woman's vagina) that, according to the data, were performed, or that they They did not believe that these procedures were medically necessary.
The WHO guidelines also state that women should have the opportunity to have skin-to-skin contact with newborns and that they should receive support regarding breastfeeding. However, mothers have been separated from children in at least 15 countries - including at least six European countries - and prevented from breastfeeding in at least seven countries, although there is no conclusive evidence that COVID-19 can transmitted through breast milk.
Most African countries are already far from meeting their targets for reducing maternal and child deaths by 2030
Doctors and health experts agree: none of the above is necessary to prevent the spread of the new virus.
Likewise, there have been multiple reports of pregnancy deaths in Africa, after transportation and other restrictions related to confinement prevented women from reaching hospitals. Many women affected in developing countries have been forced to give birth in unsanitary and unsafe conditions. Experts now warn that over the course of just six months, COVID-19-related restrictions and disruptions in health services could cause up to 56,700 additional maternal deaths in low- and middle-income countries.
If this is not enough to make visible the shortcomings of current prevention measures, let's consider how unevenly these measures are implemented (and lifted). In some parts of England, women can now take their partners to a bar, but cannot take them to their prenatal appointments.
This reflects a long history of "postcode lottery" that gives access to health care and other services from clinics fertilization in vitro to shelters for women in situations of domestic violence. And, it fits a broader global pattern of degradation of women's rights and needs, even during childbirth. Last year alone, a WHO-led study revealed that 42% of those interviewed by researchers in Ghana, Guinea, Myanmar and Nigeria said they had experienced physical or verbal abuse, stigma or discrimination in health facilities during childbirth.
In Latin America, several countries — including Argentina, Ecuador, Mexico, Uruguay, and Venezuela — have passed laws against the performance of medical procedures, such as caesarean sections, without informed consent. However, they are rarely applied, and advocates report that authorities and medical personnel normalize such obstetric violence.
In the data, before the pandemic, 40% of babies throughout Latin America were already delivered by caesarean section, although this method poses greater risks for the mother and the baby. The WHO recommends a rate of around 15%, stressing that caesarean sections should only be carried out when medically justified.
Furthermore, most African countries are already far from meeting their targets for reducing maternal and child deaths by 2030, which are part of the United Nations Sustainable Development Goals. As Jesca Nsungwa Sabiiti, Uganda's maternal and child health commissioner, has pointed out, the pandemic is likely to further delay the achievement of goals.
However, just as the COVID-19 crisis can impede progress, it can also drive change, forcing governments and civil society to rethink how our healthcare systems, our economies, and our societies are organized. So far, discussions, especially among policymakers, have tended to be narrow and focused on short-term solutions. If we want to build a post-coronavirus world that is “resilient and equitable and sustainable,” the world many leaders advocate for, we must take a much more ambitious vision of what public health really means.
In six months, restrictions related to covid-19 and disruptions in health services could cause up to 56,700 additional maternal deaths
For example, it is necessary to enact and enforce laws that protect the vulnerable. Health agencies and other government agencies should investigate violations and hold medical providers accountable. In addition, governments and donors must allocate much more resources to advocacy in problem areas such as maternal health, and implementing a rights-based approach to medical training and service delivery across the board.
The issue goes far beyond direct medical care. Today, women can be imprisoned for miscarriages (as in El Salvador) and detained for non-payment of hospital bills after delivery (as in Kenya). Structural inequality and discrimination based on gender, race, class, disability, and many other characteristics continue to shape every aspect of our lives, in both rich and poor economies. All of these failures undermine public health.
Too many women have felt alone, scared, and traumatized giving birth during the pandemic. In openDemocracy research, a woman in Italy expressed hope that policy makers and medical providers learn from her own suffering and the suffering of others like her, so that others will not have to endure what she I stand. Ensuring that these actors do learn from these sufferings is a debt we owe to them.
openDemocracy continues to monitor violations of the rights of women in childbirth globally. See a complete map and submit evidence of such violations at this link.
Mary Fitzgerald is editor-in-chief of openDemocracy.
Translation from English: Rocío L. Barrientos. Copyright: Project Syndicate, 2020.
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