Pandemic can push maternal mortality: UNFPA warns


The coronavirus pandemic is changing the pattern of health seeking behaviours of pregnant women in the Asia Pacific region and this can result in "increases" in maternal mortality, UNFPA Regional Director for Asia-Pacific Bjorn Andersson has said.

He suggested “a multilateral approach” to global crises like the pandemic as the challenges related to maternal health, family planning and gender-based violence in the countries of the region including Bangladesh were already visible.

Andersson was speaking at the second session of the virtual 10th Asia Pacific Conference on Reproductive and Sexual Health and Rights (APCRSHR10) held on Thursday, in the lead up to World Population Day 2020 which was celebrated on Saturday, on the theme: ‘Accelerating Rights and Choices for All in a Post-COVID Asia-Pacific’.

“There are changes in patterns of health seeking behaviours of pregnant women who are now fearful to come into contact with potentially COVID-19 positive individuals in health facilities,” he said. 

“In some countries there are stock-outs of contraceptives, increasing the chances of unintended pregnancies. We are observing unacceptable increases in gender-based violence as a result of lockdowns and confinement in homes with abusive partners. 

“The damaging impacts of all these will have lasting consequences that could stretch over the next decade. A multilateral approach to global challenges like the pandemic is the only way to go,” he said.

To illustrate the risks, the UNFPA regional office earlier modeled the pandemic’s possible impact on three key sexual and reproductive health (SRH) services: births assisted by skilled health-care providers, including midwives; births taking place in health facilities; and access to contraception.

They focused on the 14 countries in the Asia-Pacific region that are particularly vulnerable: Afghanistan, Bangladesh, Bhutan, Cambodia, India, Indonesia, Laos, Myanmar, Nepal, Pakistan, Papua New Guinea, the Philippines, the Solomon Islands and Timor-Leste.

All already have high maternal mortality ratios – more than 100 deaths per 100,000 live births, which often reflect lower use of health services, such as giving birth in medical facilities or with the help of skilled birth attendants.

The best-case scenario, according to the UNFPA’s model which was published on the World Economic Forum’s website, is a 20 percent decline in use of the three key services. That would lead to a 17 percent increase in maternal mortality ratio, equivalent to 25,493 additional deaths this year alone. 

The worst-case scenario – a 50 percent decline in use of services – would produce a 43 percent increase in maternal mortality, or 68,422 additional deaths. 

Of these additional maternal deaths, a considerable proportion would be attributable to the increase in fertility resulting from reduced access to contraceptive services.

Considering the impacts, the Bangladesh health ministry-formed national advisory committee on Covid19 advised the government to take measures. 

On Friday, following a meeting, they issued a statement asking all hospitals to set up separate units to ensure services to all pregnant women. They also advised ensuing proper personal protective equipment for the healthcare providers who will deal with pregnant women.

The UNFPA Asia-Pacific, in partnership with UNFPA Cambodia, the APCRSHR10 secretariat in Cambodia - Reproductive Health Association of Cambodia (RHAC) and the CNS co-hosted the second session of the APCRSHR10 which featured globally and regionally renowned advocates championing the ICPD Programme of Action and UNFPA's crucial mandate at this time of global challenge.

The ICPD changed the world – putting individual rights and choices, with a focus on sexual and reproductive health and gender equality, at the heart of sustainable development.

Over 25 years, ICPD has guided the work of UNFPA, transforming the lives of millions upon millions of women and girls the world over, and contributing to significant human rights and socioeconomic advances in Asia and the Pacific as well.

In Bangladesh too, there has been dramatic improvements in people’s lives since the ICPD.

With an average life expectancy of 73.8 years for women, this rise also denotes a “paradigm shift” in the lives of women and girls in Bangladesh, according to UNFPA Bangladesh.

Much of this success can be attributed to the culmination of rights and choices for all, especially women and girls, in the wake of the ground-breaking 1994 ICPD.

The Maternal Mortality Ratio (MMR) has decreased to 196 per 100,000 live births in 2016 from 322 in 2000. Modern contraceptive methods use rate has increased to 62 percent in 2014 from around 45 percent in 1994. 

Bangladesh has jumped 25 notches up in the World Economic Forum’s Global Gender Gap Index, placing the country on top of all south Asian countries and at 47th in the global scenario in 2017. According to the 2018 Report, Bangladesh has closed over 72 percent of its overall gender gap.

But globally COVID-19 is negatively impacting progress made on ending maternal mortality, unmet need for family planning and gender-based violence and harmful practices against women and girls – key transformative results that UNFPA and its partners are working towards. 

Bangladesh is also facing similar problems. The State of the World Population report 2020 also highlighted the need for urgent accelerated action to stop child marriage and son preference - both exists in Bangladesh.

At the launching of the report, UNFPA said they are witnessing the use of family planning methods is going down due to the Covid19 pandemic.

The UNFPA formed a task force involving key persons who work in the field of family planning in Bangladesh and formulated a policy brief and guideline for the government.

“Due to lockdown women are not going to the facility and at the same time they have fear to go to the facility (to collect contraceptive methods) for Covid19 patients,” Dr Emdad Hoque of UNFPA Dhaka Office said. “Facilities are also not making the service available.”

The UNFPA did a modeling using the lifesaving tool. “If the current coverage goes on, then the unmet need of family planning will rise to 23 percent from the current 12 percent resulting in increasing number of unwanted pregnancies and abortion and increase in maternal mortality.”

The taskforce group recommended change of the service modalities at the community level. The home to home service is not feasible due to the situation. But people can go to the community clinics which are built and family welfare centers.

He said the methods need to be made available at those centers for two months or three months instead of one month for making “more accessible and readily available of the modern methods”.

He, however, said Bangladesh does not have a shortage of contraceptive methods. “Only problem is availability.”

The regional director, Andersson, who was present at the ICPD in Cairo in 1994, said as the countries move forward in partnership and solidarity, “we must remain vigilant and uncompromising in our pursuit of human rights and gender equality.” 

“We need to hold governments accountable to their commitments to the ICPD Programme of Action and the SDGs to build a better post-COVID Asia-Pacific. 

“We need to work together for societal change - so that the lives of women and girls are valued equally with the lives of men and boys. And, we must push back against the growing trends of conservatism that threaten our collective efforts,” he said.

The first session of the six-month long 14 episodes of the APCRSHR10 was held on June 29.