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PRESSING NEED

Maternal, child health dilemma during Covid-19

Measures should be taken to ensure the safe delivery of babies.

In Summary
  • Counties must be well equipped and prepared to handle emergency antenatal and postnatal care.
  • Access to family planning services among women of reproductive age should also continue to be a priority

Access to maternal and child healthcare, including nutrition services, has been a challenge to the majority of low- and middle-income countries and now with the focus on the Covid-19 pandemic and funds being redirected to handle the disease there is a real danger that MCH will be ignored for the time being.

The World Health Organisation has warned that with all eyes on the fight against the virus people are likely to die from the indirect effects of the pandemic and Dr Richard Ayah, a health systems management and policy expert, declared recently, “We are so focused on Covid-19 that we are forgetting about other aspects of health like maternal and child health”.

Although Kenya has made great strides in reducing maternal, neonatal, infant and child mortality rates, the nightmare is far from being over.

Maternal deaths in Kenya declined by 38 per cent between 2000 and 2017 and currently stands at 362 per 100,000 live births while neonatal and child mortality rates are 19.6 and 41.1 per 1000 live births respectively, according to the statistics from the Kenya Demographic Health Survey (2014), World Bank and Unicef.

While these numbers show some improvement in the reduction of maternal and child mortality over the years, inequities in the mortality rates across the counties need to be addressed.

In some counties like the Mandera and Wajir, for instance, maternal deaths stand at 3,765 and 1,683 per 100,000 live births which is extremely high. These deaths are preventable.

Much more needs to be done for Kenya to achieve the Sustainable Development Goal 3 (SDG 3) which aims to end preventable maternal, neonatal and child deaths by 2030 to 70 per 100,000 births, 12 per 1000 births and 25 by 1000 births respectively.

Many women have died and continue to die from treatable and preventable pregnancy-related complications during and after childbirth, according to the World Health Organisation. The absence of skilled healthcare professionals has been put forward as one of the major causes of maternal and neonatal infant mortality.

While devolution of health services from the national to county governments in Kenya brought services and decision-making power closer to the people, still more needs to be done to improve access to quality antenatal and postnatal care for mothers at the health facilities throughout the country.

The introduction and adoption of Universal Health Coverage by the government in 2018 as a national priority was welcome as a sign of ensuring proper and sustainable investment in healthcare. It also brought about opportunities to push further advocacy work on the right to health and restructure priorities around maternal and child health issues in the country.

As part of the Big Four agenda, the implementation of UHC builds upon earlier efforts by the government that abolished user fees at the health facility level thus giving more needed access to essential maternal and child health services at no cost to the recipients.

Despite this progress, access to medicine, facilities and essential services including reproductive health services, remains a challenge to the majority of Kenyans, with women and children being most affected. Maternal and child health is now likely to suffer given the projections of the increase in Covid-19 related cases in Kenya and the uncertainties that it brings.

The Covid-19 pandemic and its effect on maternal and child health raises questions on the preparedness of the health facilities to handle emergency-related complications arising from maternal and child health in addition to the Covid-19 emergency.

The social and economic potential impact of Covid-19 is expected to affect most families in Kenya and particularly women and children who are the most vulnerable.

The negative impact of the current pandemic may lead to increased maternal and infant mortality rates as a result of the inequalities in healthcare access across counties. Majority of county health system infrastructure may not be able to accommodate the shocks caused by the potential surge of Covid-19 cases.

Counties must be well equipped and prepared to handle emergency antenatal and postnatal care. This may include equipping the facilities with enough infrastructure, ensuring access to skilled birth professionals to handle safe deliveries, and providing access to essential drugs for pregnancy-related and neonatal complications and infant and child illnesses after delivery.

Access to family planning services among women of reproductive age should also continue to be a priority to reduce the number of pregnancies which often lead to maternal deaths.

While there is no solid evidence to show the implications of Covid-19 on pregnant women, they can still be at risk due to the changes in their bodies and immune systems which may have their health compromised. In addition, women are the recipients of maternal health services like antenatal visits, which help reduce morbidity for the mother and baby during pregnancy and after delivery.

Thus there is an even more pressing need to ensure proper healthcare services for mothers at the health facilities in case there is a surge of number of infections due to Covid-19 crisis at the counties.

Even amidst the coronavirus crisis, we must ensure that pregnant women will still be taken care of at health facilities and that safety and precautionary measures are taken to ensure the safe delivery of babies in order to prevent maternal and infant mortality.

Trained nutritionist and public policy and budgeting expert.