Christy Turlington Burns is the founder of Every Mother Counts. Elizabeth A. Howell is chair of the department of obstetrics and gynecology at the University of Pennsylvania Health System and Perelman School of Medicine.
For women around the world, 2019 was the safest year in history to give birth. Before covid-19, pregnancy-related deaths had been declining steadily throughout much the world. Even in the United States, where maternal mortality rates are about double that of other high-resource nations, there was unprecedented momentum for legislation targeting the racial and ethnic disparities putting mothers of color at the greatest risk.
Seventeen months later, global death rates for mothers and newborns are soaring to levels not seen in decades, stillbirths have risen sharply and more pregnant and postpartum women are experiencing serious medical complications. According to new research in Lancet Global Health, the chances of a woman dying while pregnant or during childbirth in Mexico and India has jumped by more than one-third since the pandemic’s start. The United Nations estimates maternal mortality could nearly double in many Latin American countries.
Governments around the world — especially the United States — must step up to address this crisis. U.S. lawmakers can do their part by providing funding to expand access to care in low- and middle-income countries. And they must lead the way to save the lives of mothers and babies by addressing maternal health inequities, both at home and abroad.
Pregnant women with covid-19 face greater health risks, but the pandemic’s crippling impact on health-care systems is largely to blame for the spike in negative outcomes. Disruptions to health and nutrition services combined with fears about contracting the virus at medical facilities have deprived millions of expectant mothers of access to vital prenatal services. In many countries, the pandemic has shut down public transportation, community health centers and food programs, leaving pregnant women without adequate nutrition and medical care.
Women must also weigh the risks of going to a hospital, where they might be exposed to covid-19, versus giving birth at home without a skilled attendant. In places with high infection rates, hospital care might not be an option, as already scarce medical resources, such as hospital beds and midwives, are diverted to cope with covid-19 patients, limiting access to basic and emergency obstetric care. In India, the worsening health crisis has pushed the system into chaos, leaving cities such as New Delhi, with a population of more than 17 million, with fewer than a dozen intensive care beds for pregnant women with covid-19.
Meanwhile, reduced access to contraception is leading to more unintended pregnancies, putting more women at risk. The United Nations Population Fund estimates that 12 million women, primarily in low- and middle-income countries, lost access to family planning services because of pandemic-related disruptions. Those risks will worsen as the British government slashes funding for contraception in lower-income countries by 85 percent, which the U.N. Population Fund says could lead to an additional 14 million unintended pregnancies.
Even when services are restored, there will be lasting consequences as women, who may already face cultural or economic barriers in seeking prenatal and maternity care, lose confidence in health systems. Researchers at the U.N. Population Fund say lower usage of health services by women in 14 Asia-Pacific countries may have resulted in as many as 68,000 additional preventable deaths in 2020 alone.
It’s encouraging that within days of taking office, President Biden reaffirmed the United States’ support for global maternal health, restoring funds for lifesaving U.N. programs. The new White House Gender Policy Council must have enough clout within the administration to be able to deliver on promises to improve maternal health and health equity in the United States.
Meanwhile, Congress can help moms by passing the bipartisan Reach Every Mother and Child Act, which would require the creation of a coordinated strategy for ending preventable maternal deaths globally and help regain ground lost to covid-19. Closer to home, the Mommies Act and the Black Maternal Health “Momnibus” would help address racial and ethnic disparities.
But reversing the trajectory of maternal mortality requires action on a global scale, and covid-19 is at the top of the agenda at next month’s Group of Seven summit. Vaccines are vitally important, but so are the lives of vulnerable women and children. G-7 leaders should collaborate on immediate strategies to restore prenatal and postnatal care, safeguard access to contraception and alleviate the global midwife shortage. The Biden administration can further cement U.S. leadership by gaining commitments from G-7 nations to take part in a global convening in 2022, the 10th anniversary of the Acting on the Call Summit, which set out country-specific plans that have helped reduce maternal and child deaths in 24 countries.
By taking decisive action now, there’s a good chance that in 2030, we’ll once again be able to say that women around the world are living in the safest year in history to give birth.