Deaths among pregnant women, newborns to spike due to coronavirus even as they lose 20% of health services: UN
Health systems in both rich and poor nations are massively struggling and the services for mothers, newborns, young children and adolescents are crumbling, say experts
Even before Covid-19, global progress towards 2030 targets to save the lives of women and children was lagging by around 20%, and the pandemic is making a bad situation even worse. The predicted scenarios paint a grim future for women, newborns, young children and adolescents. According to researchers, the world could see a big rise in deaths among pregnant women and young children – 8% to 45% higher than would have occurred in the absence of the pandemic.
Overall, mothers, newborns, young children and adolescents are losing 20% of their health and social services due to the Covid-19 pandemic, claims a new United Nations (UN) report. In 2016, the UN Secretary-General mandated the Independent Accountability Panel (IAP) for Every Woman Every Child to review accountability and progress in women, children and adolescents' health towards the 2030 Sustainable Development Goals (SDGs).
The impacts of Covid-19 (in both real-time and in the projected implications) have been considered throughout this report and shows that the pandemic has interrupted steady progress and has led to increased poverty and unemployment. Early data finds women experience not only loss of various categories of support and social safety nets, but also an inability to access increased support, compared to men.
Researchers also warn that an estimated 20-40% of health expenditure is wasted globally due to inefficiencies and corruption. This has been a repeated finding over the past 10 years and amounts to around $2 trillion a year currently. "Besides the loss of services due to the pandemic, IAP has found that globally implementation is 20% behind on the UN's 2030 goals to reduce preventable deaths for mothers, newborns, young children and adolescents," says the study.
The panel of health experts has warned disruption to contraceptive supplies could lead to 15 million more unintended pregnancies in low and middle-income countries (LMICs). Even a 10% shift in abortions from safe to unsafe in 12 months in LMICs could lead to 3.3 million additional unsafe abortions. For every three months of lockdown, 15 million more cases of gender-based violence are anticipated. The analysis suggests that 2 million additional cases of female genital mutilation could take place over the next decade due to delays in the implementation of programs to end these harmful practices.
Due to wide-reaching economic impacts and disrupted programs, 13 million more child marriages are estimated over the coming 10 years. Researchers predict that the prevalence of wasting due to malnutrition in children could increase by 10-50%, in hypothetical scenarios used to model Covid-19 impacts. About 42-66 million children could fall into extreme poverty due to the socio-economic impacts of the pandemic, adding to the estimated 386 million children already in extreme poverty.
"Health systems in both rich and poor nations are massively struggling and the services for mothers, newborns, young children and adolescents are crumbling. Especially worrisome decline in access to life-saving vaccines for children and maternal health services due to closures and movement restrictions. Immunization campaigns are being halted and health workers are being diverted from maternity to Covid-19 units," says Dr Elizabeth Mason, co-chair of the IAP in the report.
To understand and analyze the basic needs and gaps for mothers, newborns, young children and adolescents by country, the panel created a scorecard for 193 nations, by income category, of seven key indicators. This includes maternal mortality ratio, stillbirth rate, neonatal mortality rate, under-5 mortality rate, adolescent mortality rate, birth registration (proportion of children under 5 years with civil authority registered births) and death registration.
Each indicator for the 193 countries is color-coded to depict a country's current status relative to global/country targets: dark green for surpassed, light green for advanced, yellow for intermediate and red for catching-up countries. The color-coding makes it easy to pick out the countries where mothers, newborns, young children and adolescents are thriving and countries where they need help, explains the research team.
Countries with all dark green surpassed in all seven categories are Finland, Iceland, Slovenia, Luxembourg, Japan, Norway, Estonia Sweden, Italy, Spain, Czechia, Austria, Belgium, Ireland, Germany, Australia, Israel, Portugal, Netherlands, France, Switzerland, Denmark, United Kingdom, Hungary, Poland, Greece, Croatia, Canada, Slovakia, Malta, Bahrain, Belarus, Cuba and Republic of North Macedonia. Countries that are mainly red, and catching up are Mauritania, Cameroon, Angola, Lesotho, Côte d'Ivoire, Nigeria, Guinea Bissau, the Democratic Republic of the Congo, South Sudan, Sierra Leone, Central African Republic, Chad and Somalia.
There are significant equity gaps within countries too: for example, in some countries, there is around a 50-percentage point difference between the richest and poorest in service coverage for women, children and adolescents. Black and other racial and ethnic groups in North America and Europe have experienced disproportionately high rates of morbidity and mortality from Covid-19, write authors. "The protests in the US and other countries against racial injustice in response to the death of George Floyd in Minneapolis on 25 May 2020 by the police, highlights the need to address the root causes for such inequalities and injustice at all levels," they add.
Women and children in countries with access to similar economic resources can experience different health outcomes. For example, the US spends more than twice as much on health than either Japan or France, yet children in the US are more likely to die before their fifth birthday and women are more than twice as likely to die in childbirth.
Nigeria spends around twice per capita on health than Tanzania (2017 current health expenditure per capita of $74 and $34 respectively) and service coverage is around the same. But Nigeria has over double the child mortality rate as Tanzania (120 and 53 deaths per 1 000 live births respectively). This reflects significant underlying sub-national inequalities, critical gaps in health and multisectoral service delivery and financial protection, governance and other factors that require urgent remedy and action, say experts.
"Women, children and adolescents are disproportionately affected by gaping inequities between and within countries, such as low coverage of essential health services, catastrophic health expenditures, and a projected shortfall of 18 million health workers worldwide. Women are up to 500 times more likely to die as a result of pregnancy and childbirth complications in some countries than in others," says the report.
The big 'lacks'
According to researchers, there are multiple basic problems blocking the advancement of the health of mothers, newborns, young children and adolescents. These "lacks" relate to commitments that world leaders have made at the highest level. The world needs an additional 18 million health workers, even as data emerging from countries on Covid-19 has been incomplete. Often, simple information has not been collected.
Globally, one in four births of children under five are not registered with a civil authority and only 93 out of 193 countries are currently able to register more than 80% of adult deaths. "Estimates and projections based on modeling to assess country risks and progress on Covid-19 and the health of mothers, newborns, young children and adolescents vary widely. Thus, outcomes end up patchy. The lack of relevant and accurate data constrains governments' abilities to make informed decisions to ensure people's health and wellbeing of this vulnerable group," writes the panel.
Universal health coverage is another area that needs attention. Only between one-third and one-half of the world's population were covered by the essential health services they need, including interventions for women, children and adolescents. More than 900 million people experienced catastrophic health expenditure last year, says the analysis.
Progress across other sectors such as water, sanitation and hygiene is also warranted. "From 2000 to 2017, the population using safely managed sanitation services increased from 28% to 45%. Though 60% of the global population has basic hand-washing facilities with soap and water available at home, 3 billion people still lack such facilities and 1.4 billion had no facilities at all. The UN warns that the risk of disruption to these services from lockdowns endangers health, especially from waterborne diseases and the containment of Covid-19," the authors write.
Inequities are a critical concern: there are gaping gaps between rich and poor, and racial discrimination, geographical and other factors limit access to services. "Capital regions often have higher coverage of basic health and multisectoral services than other sub-regions demonstrating sub-national inequalities. Inequities will worsen from the Covid-19 pandemic, compounded by lack of financial and social protection, and the most vulnerable, including women, children and adolescents would be hardest hit," warn researchers.
To reverse the downward turn and accelerate progress towards the 2030 targets, the IAP has set out an accountability framework. Accountability is connecting commitments to progress justifiably and constructively and has four pillars – commit, justify, implement and progress.
Stating that the pandemic has again highlighted the importance of basing critical decisions and investments for women, children and adolescents' health and rights on reliable and complete data, the panel recommends that as an urgent priority, countries should invest in data systems. This can include birth and death registration, ensuring every woman, child and adolescent counts and is counted.
"For the accountability cycle to work, an acknowledged, formal relationship is needed between the monitoring, review and recommendations, and the remedy and action that follow. All functions and features must be fully present and operational, and should be embedded in all relevant political, administrative, operational, and oversight institutions," they explain.
The authors say that the direct voices of people are crucial to effective accountability. Accordingly, it is essential that all levels of political leadership, governments, and other stakeholders "listen to, and act upon, the expressed needs and priorities of people". The team adds, "For example, sustained criticism during the Covid-19 pandemic over the lack of PPE or testing services has compelled decision-makers to take action. A global debate on racism was initiated by protests over the brutal killing by the police of George Floyd in Minneapolis. Experiences such as these should be embodied and amplified in future accountability arrangements for communities, including for women, children and adolescents' health."