Montevideo, May16, 2023 – As part of the campaign promoted by the Regional Task Force for the Reduction of Maternal Mortality (GTR, for its acronym in Spanish), Zero Maternal Deaths. Prevent the preventable, a webinar was held to present data from the study "Rapid diagnosis of factors contributing to the increase in maternal and perinatal mortality during the COVID-19 pandemic in Latin America", an investigation whose objective was to determine the ways in which health policies implemented in response to the COVID-19 pandemic affected the accessibility, utilisation and quality of maternal, sexual and reproductive health services in Colombia, Chile and Ecuador.
The meeting was opened by Alejandra Corao, Regional Advisor on Sexual Health at the United Nations Population Fund (UNFPA), who insisted on the importance of making visible the setback in maternal health indicators in the region in the wake of the COVID-19 pandemic, also highlighting the slowdown in the reduction of maternal mortality prior to that moment. Corao insisted that the study "is an input that allows us to continue advocating about what the consequences are when this happens [in reference to the COVID-19 pandemic], how external factors affect the health response and the maternal and perinatal health response" in the region.
The study was presented by Alma Virginia Camacho, principal investigator of the study and UNFPA consultant, and those responsible for the research in the three countries that took part in the study. Camacho recalled that at the beginning of the pandemic in the GTR there was concern about the effect that SARS-CoV-2 was going to have on pregnant women and, therefore, on maternal mortality. "A number of estimates were made that if coverage of essential maternal health services was reduced by 10 per cent in all low-income countries in the world, it would have the impact of 28,000 maternal deaths per year.
Joaquín Gómez Dávila, an obstetrician-gynecologist and researcher at the Colombian University of Antioquia, detailed the quantitative findings of the study, which corroborated the excess of maternal deaths in the three countries that participated in the study, with an increase in both direct and indirect maternal mortality in urban and rural areas.
This rapid assessment also included a qualitative approach based on 80 interviews to identify the factors contributing to the increase in deaths. Among some of the findings of the "three delays model", Camacho highlighted that in the three countries, lack of education and information, fear of consulting, difficulties in accessing services and the overburdening of women with caregiving tasks, among others, stood out in the first delay. Factors associated with the second delay included lack of transport and restrictions on movement, worsening economic situation and ability to pay for transport, and the closure of outpatient services and saturation of services, among others. Finally, the third delay identified, among others, the decreasing availability and locality of maternal health and sexual and reproductive health services, and the fragmentation of care.
The work leaves a series of recommendations in health emergency contexts, including the provision of governance articulation mechanisms to avoid dispersion, the preservation of maternal and perinatal health and sexual and reproductive health services, and the strengthening of the response capacity of primary health care services.
Joaquín Gómez Dávila presented the specific findings for Colombia in which he emphasised that public health and primary health care strategies were insufficient, which showed the importance of addressing the issue and the need for community networks for the dissemination of information and for training.
In the case of Chile, Jovita Ortiz, midwife and national researcher at the University of Chile, presented the relevant findings, among which she mentioned risk communication, which could discourage timely consultation, policies associated with early discharge without an intersectoral approach and gender, and the implementation of different protocols in the country's services.
Jorge Hermida, national researcher and member of the Foundation for Research and Management in Health Services presented the particularities of Ecuador and insisted that in that country, the increase in caregiving tasks, culturally assigned to women in the established model, could have influenced the delay in care, as well as the lack of information on how health centres were being reorganised.
In the closing remarks, Bremen de Mucio, regional advisor on maternal health at the Latin American Centre for Perinatology - Women's and Reproductive Health (CLAP/WR) of the Pan American Health Organisation (PAHO) pointed out that "the contribution of this study to position ourselves for future pandemics, bearing in mind that the bad things that happened were due to the measures we took because we did not have all the knowledge and we wanted to be protectors, but rather than protectors, we ended up being aggressors from the systems".
The webinar was moderated by Ariadna Capasso, technical secretary of the GTR.
The study was supported by Momentum Country and Global Leadership and UNFPA, and was coordinated by the Centro de Estudio de Estado y Sociedad (CEDES) Argentina.