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Geography is the key to being born or dying in childbirth

“My 37 week old baby was dead before I could have given birth. And they couldn’t detect the cause, even though her umbilical cord had many knots. It was so painful. ” The one speaking from Kigali is Sabine Uwizeye, a 35-year-old Rwandan woman who lost her first child before birth five years ago. This mother is one of the visible faces behind a tragic statistic. Every year, almost two million babies die before or during childbirth, that is, one every 16 seconds, according to the study A forgotten tragedy: the global burden of fetal mortality, the first index on this issue jointly carried out by the World Health Organization (WHO), the World Bank, the Population Division of the United Nations Department of Economic and Social Affairs (UN DESA) and Unicef.

The death of these babies before delivery is also determined by the social and economic development of each region. 84% of these deaths occur in low- and middle-income countries, especially in Sub-Saharan Africa and Southeast Asia. “Guinea-Bissau, Central African Republic, South Sudan, Pakistan and Afghanistan are some of the countries that have to accelerate their work in preventing these deaths”, contextualizes Danzhen You, coordinator of the Inter-institutional Group for the Estimation of Mortality in Childhood of the United Nations (IGME) that carried out the report. Collecting the data took two years of work. Even so, explains the expert, 62 countries of the 195 in the world have not been able to provide figures, since this specific mortality ratio is not exhaustively monitored. “This problem remains invisible and is not a priority in the national health plans of many regions,” he laments.

The pandemic, one more factor for the setback

The collateral damage of the health crisis is felt in more areas. The report warns that measures taken to combat the pandemic could worsen the global number of babies killed before birth. A 50% reduction in health services could cause nearly 200,000 additional deaths in one year in 117 low- and middle-income countries. According to the study carried out by researchers from the Johns Hopkins Bloomberg School of Public Health this corresponds to an increase of 11.1% in deaths in the same period of time. In 13 countries it could be as much as 20% or more.

“Covid-19 has triggered another devastating health crisis for women, children and adolescents due to disruptions to life-saving health services,” explains Muhammad Ali Pate, Global Director of Health, Nutrition and Population at the World Bank. There are many voices of experts who have come together to express their concern about the decline that the coronavirus is going to mean in the fight against other diseases, such as malaria, AIDS and tuberculosis, but also in the halt in the improvement of the data on infant and maternal mortality that had been produced. “Pregnant women need continuous access to quality care, throughout their pregnancy and during delivery. We are supporting countries in the strengthening of their health systems to prevent fetal death ”, emphasizes Ali Pate. WHO, which declared 2020 as the year dedicated to nursing and midwives, also joins this request. “The tragedy of stillbirth shows how vital it is to strengthen and maintain essential health services, and how critical it is to increase investment in nurses and midwives,” said Tedros Adhanom Ghebreyesus, CEO of the organization.

The best prevention, a doctor nearby

Idowu Adelabu has spent years assisting pregnant women as a midwife at Obafemi Awolowo University Hospital in Ife, a city in southwestern Nigeria. Despite her experience, she does not get used to the sensation of the death of a baby before birth. “It is heartbreaking to see a woman who has undergone a pregnancy process for more than half her total gestational age – more than 28 weeks – and she begs you to save her child. Especially here in Nigeria, where we know that most causes of fetal death are preventable. “

More than 40% of deaths occur during childbirth, according to the same study. Of this 40%, half are produced in Sub-Saharan Africa and Southeast Asia and Central Asia, while in Europe, North America, Australia and New Zealand the percentage is 6%.

The experts’ recommendation to prevent these deaths is the assistance of a qualified health professional during delivery and timely obstetric care in cases of emergency. “A reduction in the rate is possible in Nigeria if health services were accessible and affordable for all pregnant women,” claims Adelabu, who explains that many low-income women do not go to maternity services due to lack of money to pay them.

The other big challenge facing Nigeria, according to Adelabu, is that many women still give birth at home, without qualified assistance. “It is necessary that the Government invest in programs that can help in the training of traditional midwives because many pregnant women still use their services,” asks the midwife.

Socioeconomic status is also a factor that influences whether there are more or fewer fetal deaths, according to the report. For example, in Nepal, minority caste women had mortality rates between 40% and 60% higher than upper class women. Furthermore, rural areas are more affected than urban ones. “We know that one of the serious problems in some areas is the lack of transportation and the remoteness of the population from a health center, so it is crucial that an enormous amount of training and awareness work be done in these communities and that materials and supplies be provided. adequate resources, ”says expert Danzhen You.

Other consequences, also serious, are the mental consequences that are very often invisible. “In addition to the loss of that life, the psychological and financial impact on women, families and societies is significant and long-lasting. For many of these mothers, this should not happen. This is how Sabine Uwizeye feels, now with a 10-month-old girl, who remembers what it was like to go through the trance of a lost son. “Being in the same room with other mothers carrying their babies was unbearable. At home, I didn’t stop crying day and night ”. Avoidable pain, having taken measures in time.

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