BLANTYRE, Malawi (AP) – Prenatal care at the health clinic was free, but the motorcycle taxi was more than Monica Maxwell could afford. Just four weeks before her baby was born, she cobbled together 1,400 kwacha ($ 1.75) for the 50-kilometer round trip. It was only her third visit – less than her first two pregnancies. The money she made selling tomatoes in the local market dried up due to the pandemic. Her husband’s income from the sale of goat meat also fell.
“It was the most difficult time of our life. We had no money to survive, ”said Maxwell, 31, while she and other women waited outside to be seen by a medical midwife. “We stayed at home most of the time.”
In a country where hospitals are so empty that women are expected to bring their own razor blades to cut their babies’ umbilical cords, the increasing poverty caused by the pandemic continues to put women’s lives at risk.
Officials say far fewer pregnant women in Malawi are getting the medical care they need amid the pandemic, with many foregoing medical visits and relying solely on traditional obstetricians for emotional support and traditional herbal treatments, but technical from the government are forbidden to deliver babies due to their lack of formal training. Many families cannot afford hospital visits or, like Maxwell, transportation there; They also fear that they will contract the coronavirus in a medical facility.
At risk are the gains Malawi – a largely rural part of a country of 18 million people – has made over the past decade in fighting the poor record of maternal mortality. According to the United Nations Population Fund, women in Malawi have a 1 in 29 risk of life-long death from pregnancy or childbirth. The country has 439 such deaths per 100,000 live births – a number that had to be reduced from 984 per 100,000 in 2004 as women gained better access to medical care, especially in emergencies.
Still, Malawi’s rate is the third highest in southern Africa. The rates are 19 per 100,000 births in the United States and 7 per 100,000 in the United Kingdom.
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This story is part of a year-long series on the impact of the pandemic on women in Africa, worst in the least developed countries. The series of AP is funded by the European Journalism Center’s European Development Journalism Grants program, supported by the Bill & Melinda Gates Foundation. AP is responsible for all content.
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Malawian hospitals also suffered from staff shortages when nurses were mobilized to treat coronavirus patients – resulting in a certain lack of skilled labor for childbirth, said Young Hong of the United Nations Population Fund.
“The pandemic not only affected the availability of labor, but also put great pressure on the entire health system, including the shortage of certain drugs, equipment and basic medical supplies such as surgical gloves,” said Hong, who found eight Malawian women die every day Pregnancy complications far higher than the COVID-19 toll. “This had a huge impact on the quality of maternal health care during the pandemic.”
At the Ndirande Health Center, just northeast of the country’s commercial capital, Blantyre, around 100 women attended prenatal services every day before the pandemic. When COVID-19 surfaced, that number fell by half and is now only 15 to 20 patients, said Jacqueline Kolove, a nurse at the clinic.
Sometimes even the women who come for prenatal care are afraid of giving birth in the clinic during the pandemic and prefer to give birth at home. Malawian women are encouraged to give birth without medical intervention, and many here consider emergency measures such as a caesarean section to be shameful and a sign of weakness. The decision to give birth at home can be fatal, however – most women live too far away to make it in time if a dangerous complication occurs.
“We explain to them why such a decision could have dire consequences … sometimes their husbands and parents even call to try to talk to them,” said Kolove.
At Ndirande and other clinics, nurses, assistants, and medical midwives give pregnant women ultrasounds and use devices to monitor the vital signs of the mother and baby. A woman can have a caesarean section if necessary, and medication is available to stop heavy bleeding. Clinical staff take medical courses, observe simulated births, and become licensed.
Traditional obstetricians learn from elders who pass knowledge down through the generations and use little to no medical equipment – for example, they listen to women’s stomachs by placing their ears there and collect herbs to induce labor. They say that certain herbs cooked in a dark green liquid can treat situations like coccyx babies who need to change position.
The government banned the use of traditional obstetricians in 2007, but the practice continued and the ban was rarely enforced. Some servants do not ask for anything and they have seen more women come to them during the pandemic. Caregivers like 56-year-old Lucy Mbewe, who has given birth to an estimated 4,000 babies since 1983, say her job is key for women who can’t afford anything else.
Even the brightly colored African cloth often used to swaddle babies, carry them on mother’s back, or make makeshift diapers can be a potential obstacle to care, Mbewe said. “The state hospitals recommend that a woman giving birth must have at least 10 items of clothing with her, which will put off those who cannot even afford to put food on the table,” she said.
In government institutions, Malawian women are even expected to bring a blanket for the delivery bed, buckets for water, and sometimes candles or flashlights. Mbewe provides clothes and soap when helping women with childbirth. She pays for the home transport. Some women are so grateful that they come back to pay them; She uses that money to look after other customers in need, she said.
However, medically trained midwives say the increased use of caregivers has led to an increase in complicated births, with women only going to the hospital when it’s too late to rescue them. Mbewe says the complications aren’t caused by the traditional caregivers, but rather due to expectant mothers getting pregnant at a younger age – a trend confirmed by a government report.
Midwives and health officials also say they are fighting misinformation about the virus and vaccines that are preventing women from getting adequate medical care. Malawi did not have a full social lockdown and saw a dramatic increase in coronavirus cases, part of a surge in southern Africa. Experts believe cases are under-counted and concern about the vaccine is widespread.
The Malawian government has given fewer than 213,000 doses of the AstraZeneca vaccine. And officials destroyed about 20,000 expired doses of COVAX, the UN-sponsored program to ship vaccines to poor countries. Across Africa, only 1% of the population of 1.3 billion people in 54 countries has received a dose of the vaccine, according to the Africa Centers for Disease Control and Prevention.
Nurses and midwives say some women fear they will be secretly receiving the vaccine if they give birth in a medical facility.
“They feel like we, as health workers, are giving them the COVID-19 vaccine instead of oxytocin,” said Kolove, the Ndirande Health Center nurse, referring to medications that increase labor and reduce the risk of bleeding. “They feel that we are cheating on them. As a result, there are some cases where women refuse. “
Medical staff also know that they and the women they treat are at greater risk of contracting the coronavirus. The medically trained midwives are trying to educate women and they are taking all possible precautions against the virus even though their job of giving birth makes it impossible to maintain physical distance, said Keith Lipato, president of the Malawian Midwives Association.
“We ensure that all midwives are screened and tested so that those with signs and symptoms are released from work and receive the necessary medical treatment so they don’t infect clients and patients,” said Lipato.
However, the precautionary measures do not convince many expectant mothers. Five months after her pregnancy, Margret Kosamu has to go to a clinic. Instead, the 30-year-old turned to a traditional obstetrician for just two visits. Her family’s farm income has fallen, but it’s not just about money; She fears that going to a medical facility might kill her, not save her life.
“You are more likely to get infected with the virus in the hospital than here,” she said of the care of the nursing staff.
Lipato and other health professionals fear the pandemic will have long-term health implications for women in Malawi and beyond.
Patricia Gunde, 26, did not receive any prenatal benefits during her first pregnancy. She prefers to receive the herbs instead, which her caregiver says will stay healthy and speed up labor. Gunde has no plans to get a COVID-19 vaccine.
“I’m scared,” she said. “I’ve heard a lot of stories about it.”
She feels comfortable with the traditional obstetrician because the women are seen individually.
When the nurse brings Gunde to the nursing home, nobody wears a mask.
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AP authors Krista Larson in Dakar, Senegal, and Andrew Meldrum in Johannesburg contributed to this.
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Check out the full series on how the pandemic is affecting women in Africa: https://apnews.com/hub/women-the-eyes-of-africa
Gregory Gondwe, The Associated Press
source https://dailyhealthynews.ca/fearing-covid-struggling-malawian-women-forgo-prenatal-care/
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