The Covid-19 pandemic has exposed the fragility of health services in many poorer countries, leaving women and children especially vulnerable.
Governments urgently need to double down on the provision of basic care if years of progress are not to be lost. The worst health crisis in a century has already caused more than 500,000 deaths, but a much larger health catastrophe is looming.
Tens of millions of women and children may die or endure lifelong health impacts because of disruptions to essential health services and the reluctance by patients to seek care for fear of Covid-19 infection.
New data from Somalia, Mali, and Liberia shows up to a 40 per cent reduction in essential health services such as childhood immunisation, antenatal care and safe childbirth.
The Global Financing Facility (GFF) estimates that as many as 26 million women could lose access to contraception across 36 countries, leading to nearly 8 million unintended pregnancies.
More children are missing vaccinations and more women are giving birth without medical help. Our surveys show that in nearly all of our 36 lower-income partner countries, the pandemic has disrupted the ability of health care workers to stay on the job for a number of reasons, including high rates of infection, lack of personal protective equipment, and inability to travel because of lockdown measures.
Three quarters of these countries have also experienced severe shortages of essential medicines like antibiotics for pneumonia, the leading cause of childhood death, and oxytocin, which stops excessive bleeding after childbirth. Past epidemics foreshadow the potential scale of the danger.
Estimates recently published in The Lancet suggest that if Covid-19 causes similar levels of disruptions to health services as seen in 2014-15 West African Ebola outbreak, almost 1.2 million children and 57,000 mothers could die within six months – a 45 per cent increase in existing child mortality levels.
More men than women are dying of the virus – perhaps because of gender-based immunological differences – yet in many cases women around the world are suffering some of the most severe knock-on effects.
For example, women are more likely to be victims in the spike of domestic violence that researchers fear is being fuelled by economic hardship as tens of millions of people are pushed into extreme poverty.
It doesn’t have to be this way. Global leaders launched the GFF five years ago to supercharge investments in high-impact – but historically under-funded – global health needs for women, children and adolescents.
The GFF championed a more sustainable approach: empower governments to bring partners together to support a prioritised, costed national plan to accelerate improvements in women, adolescent and child health and well-being.
Before Covid-19 hit, this approach was working. In partner countries like Tanzania, the first country to join the GFF, most indicators of health care for women and children saw improvement in the last five years.
From 2015 to 2019, Kenya increased its postnatal care coverage from 52 to 78 per cent, and during the same time period the percentage of deliveries attended by skilled workers increased from 54 to 64 per cent. Kenya also showed a significant increase in domestic budget allocated to health on county level.
In Ethiopia, one of the first countries to pioneer the GFF’s catalytic funding model, childbirths attended by skilled health workers rose from 28 to 50 per cent between 2016 and 2019, and the number of children under two receiving nutrition support rose from 27 to 44 per cent.
Thanks to dedicated health care workers and a concerted drive by governments and global partners, maternal deaths in childbirth had dropped by nearly 40 per cent since 2000, while infant mortality rates had fallen by 46 per cent since 2000, according to estimates from a UN interagency group.
Still far too many women and children continue to die from preventable causes, but progress was headed in the right direction.
Sadly, these and many other advances are now in jeopardy due to Covid-19. The GFF’s Covid-19 response is focused on three areas in line with our core mission to promote better health outcomes for women, children and adolescents.
First, we are helping countries prioritize and plan for continuation of essential health services.
Second, in collaboration with the World Bank and other partners, we’re helping countries strengthen their frontline service delivery to ensure the continuation of essential reproductive, maternal, newborn, child and adolescent health services.
Third, we are addressing constraints in demand for health services – which we are seeing as a rising constraint. In addition to protecting essential health services in the short-term during this pandemic, the world can stanch the bleeding from this and future global health crises by investing in more resilient and equitable primary health systems in the poorest countries.
As leaders fight the battle against the pandemic, they must not abandon the global war against maternal and child mortality.
The choice is clear: act now to ensure women and children can access the health care they need to thrive, for themselves, communities and economies, or roll back years of hard-earned progress. The stakes have never been higher.