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Baby boom and overburdened facilities: A doctor's view on Covid-19 aftermath

Need for immunisation will increase as well as pregnancy-related complications

In Summary

• Hospital visits for contraception is secondary and may never be a priority to most families.

•Apart from increased pregnancies, mental illnesses, HIV and other Sexually transmitted illnesses may rise.

A file photo of the maternity wing at Mbagathi hospital in Nairobi.
A file photo of the maternity wing at Mbagathi hospital in Nairobi.

The routine lifestyles of most people have been disrupted and many forced into the captivity of their homes after the presidential declaration of curfew on March 27.

Usual entertainment events such as football, the English Premier league, the 2020 Tokyo Olympics, the spanish MotoGP and others like boxing, are no longer available.

There is no live sports worldwide and the only option left is to replay old ones, sometimes irrelevant to the existing modern generation and the prevailing socioeconomic circumstances. 

With the 10 hours of dusk to down curfew, people are now compelled to return home too early.

One single, rarely monotonous activity, and the only left option for entertainment, may be sexual intercourse.

The confinement is a predisposing factor to more regular sexual intercourse than before.

NINE MONTHS LATER

The need for immunisation will consequently rise too, as will be the inevitable pregnancy-related complications.

Despite the freedom enjoyed before Covid-19, allowing 24 hours of activities, uptake of conventional contraceptives has been sub-optimal and thus unmet need for contraception is high.

The restricted movement will certainly worsen the low contraception uptake since priority of most families is to maximise the free time into income-generating activities and provide bread to their families.

In a background of preexisting poor health seeking behavior, the main reason for cancer diagnosis at advanced stages, hospital visit for contraception is secondary and may never be a priority to most families.

Hospital visits, as usual, are now left for individuals in unbearable distress and pain as we see with the reduced patient workload. Routine medical check-ups requested frequently simply due to unwarranted anxiety or panic have become rare.

 

Success rate of pregnancy is directly proportional to the frequency of unprotected sexual contact.

Working from home is perfect for this since the always-absent spouse is confined and readily within reach and for unusually longer time - 10 hours confined indoors.

Take note that distribution of condoms has become a rare vocabulary for the public health implementers and all efforts are directed to hygiene practices. Apart from increased pregnancies, mental illnesses, HIV and other Sexually transmitted illnesses may rise.

Nine months or shortly earlier from March 27, we shall expect a baby boom potentially overstretching the ill-equipped maternal and child health care facilities.
 
The need for immunisation will consequently rise too, as will be the inevitable pregnancy-related complications.
 

Widened gap for contraception access and the probable increased existence of unwanted pregnancies with the associated distress will certainly culminate to 'illegally’ induced abortions and thus increase potential to maternal mortality/morbidity.

We are planning for Covid-19 mitigation and mobilizing resources for the same but forgetting the potential increased demand for routine health care services as specified above as deliveries, abortions and post-abortion care, immunization of children, vitamin A supplementation, increased demand for blood transfusions to correct postpartum hemorrhage and the increased demand for antenatal care services.

If we ignore the future in our today's planning, I feel and warn that Covid-19 outbreak may not be a big problem as it is portrayed now, but a trigger of a vicious cycle of preventable losses of lives and deteriorating health indicators due to the simple possibility of demand, exponentially superseding supply of an essential and in fact basic human need, routine health care.

Let's increase access and availability of contraception with the same vigor that we are mobilizing resources towards mitigating Covid-19.

Dr Thedeus Owiti
Dr Thedeus Owiti

There already exists the community health strategy; strengthening it now is a great opportunity as more people will be easily found in their households, for contraception and fertility-related education.

In addition, the public already enjoys certain services for free in all government hospitals and planning for increased demand is imperative.

These services are antenatal care, maternity care, and child healthcare, immunisation services, HIV diagnosis and treatment, tuberculosis/leprosy treatment and care, and malaria among other services.

My interest lies with maternal and child health. Maternal and infant mortality/morbidity is unacceptable as this is the source of the country’s citizens and future generations.

The increased government's allocation of funds towards Covid-19 must equally target antenatal, maternity care and midwifery services, especially in government hospitals.

Dr Thedeus Owiti is a senior medical officer and the MOH, Rachuonyo South