Coronavirus and discrimination increase maternal mortality in Latin America

During the corona pandemic, in many Latin American countries, little attention has been paid to pregnant women – an at-risk group. As a result, the number of maternal deaths is increasing again.

Brazil has had the dubious honor of emerging as the Latin American champion for maternal mortality from the coronavirus pandemic. The country saw a 77 percent increase in women’s deaths during pregnancy or shortly after childbirth between 2019 and 2021.

In Latin America’s largest and most populous country (214 million people), an average of 1,575 women die each year before the pandemic during or shortly after childbirth. Two years later, that number rose to 2,787, according to preliminary data from the Ministry of Health.

Brazil has had the dubious honor of emerging as the Latin American champion for maternal mortality from the coronavirus pandemic.

Mexico, the second most populous country (129 million people), saw a 49 percent increase, and Peru, a country of 33 million, saw a 63 percent increase in maternal deaths. Colombia has no recent data, but the government is aware that Covid-19 was the leading cause of maternal deaths in 2021.

According to experts and women’s rights activists, Brazil is a stark example of how a combination of political mistakes and constant denial has led to a large number of preventable deaths, particularly of pregnant women.

Maternal mortality has always been a major problem in Latin America. The Pan American Health Organization (PAHO), the regional arm of the World Health Organization (WHO), states that “the maternal mortality rate is unacceptably high” and that deaths are “usually preventable”, particularly those affecting pregnant women in rural areas. .

Insufficient care

“Inadequate prenatal and obstetric care”, largely due to insufficient medical training in these areas, is the root cause of Brazil’s tragedy, says physician and epidemiologist Daphne Ratner, professor at the University of Brasilia and chair of the Humanization of Birth Care Network. The main cause of death in Brazil is hypertensive syndrome (severe high blood pressure). So something goes wrong with simple diagnosis such as high blood pressure and monitoring it during pregnancy and childbirth.

Of the 38,919 maternal deaths between 1996 and 2018 in Brazil, there were 8,186 deaths from hypertension and 5,160 haemorrhages, according to a report by the Ministry of Health. These are direct obstetric causes, accounting for just over two thirds of deaths. The rest had indirect causes, pre-existing conditions that complicate childbirth, such as diabetes, cancer or heart disease.

The epidemic has made the situation even more dire.

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Another factor in mortality is the large number of cesarean deliveries. This constitutes an “epidemic” of 1.6 million surgeries per year – about 56 percent of the total number of births – as recognized by the Ministry of Health. The rate of cesarean deliveries in private hospitals is 85 percent and in public hospitals 40 percent, both well above the 10 percent recommended by the World Health Organization.

This is not obstetrics, this is surgery. “They don’t know how to provide clinical care, and the result is more maternal deaths,” Ratner said. The epidemic has made the situation even more dire.

Mother Genocide

Brazil set a target of reducing maternal mortality by 75% by 2015, but failed to achieve it. The maternal mortality rate per 100,000 live births decreased from 143 to 60, a decrease of 58%.

It helped Stork NetworkIt is a government drive to improve support for pregnant women and maternity hospital infrastructure, make childbirth more humane, and facilitate better family planning and child care.

But COVID-19 and the government’s response to it has caused a significant reduction in maternal deaths in Brazil.

The Bolsonaro administration’s response to the pandemic has exacerbated deaths in general, and maternal deaths in particular.

Corona virus has killed more than 2,000 women during pregnancy and after childbirth in the past two years. In addition, at least 383 more deaths were recorded in this group as a result of acute respiratory syndrome likely caused by Covid-19. That is the view of the Women’s Health Network, an activist movement that has been campaigning for sexual and reproductive rights since 1991.

Fania Necker Soares, a nurse and member of the Women’s Health Network, said the way in which far-right President Jair Bolsonaro’s government acted “was genocidal or a mother”.

The response to the epidemic has exacerbated mortality in general, and maternal mortality in particular. It took more than a year for health authorities to realize that pregnant women represent a group at high risk of contracting COVID-19. Soares said this made it more difficult for them to receive intensive care and vaccination in a timely manner.

Even worse, Soares says, the Stork network has been dismantled, despite the promising results of this policy. Instead, a new Mother and Child Care Network (RAMI) has been created, which focuses all power on doctors and hospitals, at the expense of other stakeholders and dialogue.

Under-registration and neglect

The maternal mortality rate may be higher than current figures show. Testing for COVID-19 has started very slowly in Brazil, and has not taken place on a large scale. Because of this, it is likely that many mothers died without the correct diagnosis, especially in the first year of the epidemic, says Ratner.

A study published this month in the scientific journal scalpelwhich includes the experiences of families of 25 pregnant women who died from COVID-19, talks about three cases that often resulted in maternal deaths.

Maternal mortality is likely to be higher than current figures show.

First, doctors refused to hospitalize or examine women who had complaints, for example, of breathing difficulties. They attributed this to pregnancy and delayed diagnosis.

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Edgaras Vaicikevicius (CC BY-NC-ND 2.0)

In other cases, care centers have turned away pregnant women under the guise of Corona guidelines, arguing that they cannot accept pregnant women due to the risk of transmitting infection to them. Pregnant women have also been kept away from the maternity wards due to the risks of infection with the Corona virus.

Finally, pregnant women who were able to be admitted to the hospital were denied access to intensive care, on the basis of protecting the child’s life. Thus, it was decided to save the child at the expense of the mothers without consulting the parents. The numbers confirm this: all 25 pregnant women died, but 19 children survived.

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Sociologist Ligia Cardieri, coordinator of the Women’s Health Network, said women should be given a greater role “so that they can control the maternity process, including childbirth”.

Other recommendations to prevent maternal deaths include fewer mechanical interventions, fewer high-risk caesarean sections, and greater involvement of nurses and other health professionals, she says by phone from Curitiba, in the southern state of Paraná.

In other Latin American countries, pregnant women infected with Covid-19 have faced a similar lack of attention. A survey of 447 pregnant women from eight countries, including five from South America, two from Central America and one from the Caribbean, found that nearly a third of them did not receive intensive care or respiratory support during the pandemic. .

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