Written By: Nour Eltahla
March 16, 2022
The COVID-19 pandemic has not only exposed but also exacerbated the existing inequities in our societies, especially inequities in health, access to health, and health outcomes. Our FIP EquityRx Collection “Inequities unmasked” provides various examples of this. These inequities are also reflected in maternal health and maternal mortality rates which, unfortunately, were given little attention during the pandemic.
According to the World Health Organization (WHO), about 810 women died every day globally in 2017 from preventable causes related to pregnancy and birth, meaning that in that year alone, about 300,000 women lost their lives for causes that could have been avoided with better, equitable health services. This, however, is a global estimate and some countries have higher mortality rates than others. Unfortunately, some studies show that during the pandemic, and especially in low- and middle-income countries, maternal mortality rates have increased. The pre-existing inequities in the care provided to women during pregnancy, birth, and postnatal periods – all of which require frequent visits to health providers – have worsened for several reasons.
Poverty is the leading cause of maternal mortality. Access to health facilities is already difficult to some women, especially to those in low-income countries where expectant mothers must travel long distances to reach the closest health facilities. The pandemic and its lockdown measures have made this already limited access even more difficult, sometimes impossible. To make matters worse, even if health facilities were accessible, health providers are not always available due to the shifting priorities at primacy healthcare levels. The health workforce, including midwives and informal caregivers, is overstretched, and has shifted its efforts to fight the pandemic.
Literacy, particularly health literacy, also plays a critical role in this issue. Educating a society, especially women, leads to better health outcomes. Literate women have better family planning methods and seek medical care when needed. They have better knowledge of how to better take care of themselves and their children. The spread of misinformation and myths on COVID-19 and the vaccine increased vaccine hesitancy, which led to fear of contracting the virus during care visits, and eventually to fewer visits. This heightened the risk of complications and death before, during, and after delivery for both the mother and the infant.
Tailoring the healthcare system to match the needs of a population can be just as important as the quality of healthcare provided to them. Taking into consideration cultural beliefs and practices, such as the preference of traditional birth attendants, can help identify the root causes of maternal mortality. Another example is the prevalence of early marriage, for cultural or religious reasons, which leads to higher mortality rates in young girls who do not know how or when to seek medical care.
It is important to highlight the critical role that pharmacists can play when addressing the pre-existent inequities in maternal health and mortality rates. The accessibility of pharmacists holds a great advantage. By being available every day of the week, for 24 hours a day in some places, pharmacists can build trust with the community they work in by addressing their needs and concerns when needed, and by providing guidance, or even comfort for concerned patients. Pharmacists can thereby have a great impact on the health literacy levels of a population, and in this case, raise awareness on the importance of maternal health. By visiting their local pharmacy, expectant mothers can be informed on how to better take care of themselves and their children, when to seek medical care, and how to make informed decisions on family planning.
Whether caused by poverty, low literacy, distance to facilities, or cultural norms, maternal mortality must not be ignored. Hundreds of mothers are lost every day due to preventable causes, possibly at higher rates now due to the COVID-19 pandemic. This issue requires us to address not only the inequities in health, but also all the existing socioeconomic inequities. Providing accessible healthcare services that are tailored to match the needs of a population can make a huge difference. Empowering women and educating them on the risks of early marriage and pregnancy can help reduce maternal mortality in young girls. Educating and training the health workforce, especially pharmacists due to their accessibility, as well as empowering informal caregivers on pregnancy and birth can help minimise the risks of complications that may occur during those times and hence reduce mortality rates in both women and their neonates.