Do everything to reverse surge in maternal mortality post-Covid

The pandemic caused significant disruptions to healthcare services, including maternal and child health. [iStockphoto]

As the world grapples with the escalating cost of living and the devastating effects of climate change, yet another UN report on maternal mortalities was released last week, revealing alarming findings.

What is particularly worrying is that 70 per cent of all maternal deaths occurred in sub-Saharan Africa, with countries such as Kenya recording a worsening trend.

As I read this report, I was reminded of a personal tragedy: The death of a 28-year-old relative while giving birth. The loss of a young mother and the far-reaching implications is heart-wrenching. Yet, it is becoming all too common in many communities.

Kenya has been on a steady trend towards attaining 113 per 100,000 mortalities by 2030 (Vision 2030). Unfortunately, the UN report on maternal mortalities shows that we are moving in the opposite direction.

The report reveals a worrying upsurge in the maternal mortality rate (MMR) from the pre-Covid value of 335 per 100,000 live births (Kenya Population and Housing Census, Analytical Report on Mortality) to 530 per 100,000 live births (UN report on maternal mortalities 2023). This is a significant increase that cannot be ignored.

As we analyse the data, it is crucial to consider how the Covid-19 pandemic has impacted our health system. To measure our health system's resilience, we can use maternal, newborn and child health coverage indicators. A deep dive into these indicators can help us better understand the potential effects of Covid-19 and climate change on maternal health.

Medic at Rabai sub-county hospital in Kilifi County attending to a pregnant woman. [Marion Kithi, Standard]

The pandemic caused significant disruptions to healthcare services, including maternal and child health. This, coupled with the devastating effects of climate change, has created a perfect storm for maternal health service provision in Kenya.

A resilient health system is one that can withstand and recover from shocks, whether they are natural disasters, disease outbreaks or other socio-economic crises. This ability to maintain or improve functions and meet health system objectives despite crises can be measured against five key aspects.

The first aspect is the system's ability to detect threats before they strike. This means having effective surveillance and monitoring systems in place that can detect potential health threats and respond quickly to prevent or mitigate their impact.

The second aspect is adaptability, or the system's ability to rebound from shocks and adjust to new conditions. This includes having contingency plans in place, as well as the flexibility to quickly adapt to changing circumstances. The third aspect is integration, or the system's ability to rapidly deploy resources from beyond the health system.

This means working closely with other sectors to ensure a coordinated response. The fourth aspect is self-regulation, or the system's ability to prevent disruptions from turning into worse disasters.

This includes strong governance structures, effective regulation and transparent and accountable decision-making processes.

Finally, a resilient health system must be diverse enough to include social determinants of health aimed at achieving universal health coverage. This means addressing the underlying social, economic and environmental factors that contribute to health outcomes such as poverty, education, and access to clean water and sanitation.

By focusing on these five key aspects, we can create a health system that is able to provide continuous and uninterrupted primary health services, even in the face of crisis. Maternal mortality as a measure of health system resilience and the impact of Covid-19 on maternal child health services, raises many questions.

Maternal mortality is a measure of health system resilience. [iStockphoto]

Specifically, how did the pandemic affect access and utilisation of these services at the peak of the pandemic? How did it affect the three delays that often lead to maternal mortalities: One, decision to seek health services; two, reaching the appropriate health services and three, receiving appropriate health interventions while at the health facility?

And, have we delved into the differential causes of these deaths as highlighted in the confidential inquiry for Maternal Deaths report? Perhaps it is time we refocus our energies towards primary healthcare services, and take a closer look at the social determinants of health.

As a mother in Turkana battles hunger pangs while struggling to access healthcare services over 30km away, we must ask ourselves if we are doing enough to provide a holistic solution.

Health actors must therefore be more focused and act on findings from such reports rather than shelve them as other surveys are being undertaken.

As more partners join the government in delivering primary healthcare, developing primary care networks is necessary ingredient in building resilient health systems and in reversing the concerning trends in maternal mortality.

Let us come together and act to prevent maternal deaths and promote the health and well-being of mothers and their babies.

A resilient health system is not just about surviving a crisis, it is about ensuring that all members of our society get lasting health solutions to live healthy and fulfilling lives way after the crisis has been managed. By doing so, we may even exceed the Vision 2030 goal.