Maternal and neonatal deaths increase during two years of Covid

Many expectant mothers didn’t go to hospital fearing Covid. Meanwhile, the deaths were high in number as hospitals lacked proper treatment facilities.

Prothom Alo illustration

Maternal and neonatal mortality rates at government hospitals soared high during the two years of the extensive Covid outbreak. Compared to pre-Covid 2019, the maternal death rate escalated 44 per cent in 2020 and 13 per cent in 2021.

During that same period, neonatal death rates increased one and six per cent respectively. Health experts believe that maternal and neonatal mortality rates had gone up due to the healthcare system being disrupted and less people visiting hospitals for child delivery.

This information was found after analysing child delivery, birth and neonatal death records at 586 hospitals under the management of Directorate General of Health Services (DGHS). Of the 586 government hospitals, there are 430 health complexes, 33 medical college hospitals and 123 district level hospitals of 10 to 250 beds.

Analysis of the DGHS data revealed, during the two years of high Covid prevalence, the rate of seeking maternity care had decreased by 10 to 18 per cent.

However, the rate of availing service at hospitals has gone up again resulting in the decline in mortality rates this year.

In comparison to 2019, maternal deaths have decreased by 19 per cent and neonatal deaths by 12 per cent in seven months starting from January to July of the current year.

Physicians say, expectant mothers couldn’t be provided proper maternity care at hospitals when during the the upward trend of Covid. Many pregnant women didn’t even go to hospital for fear of contracting corona.

Maternal and neonatal deaths rose due to various reasons like critical health condition caused by the lack of proper care prior to delivery, absence of medical care at hospitals while giving birth, or giving birth in unhygienic environments, infants being born with low birth weight and lack of proper neonatal care.

Records of the 586 hospitals indicate that 967 mothers and 6,846 newborns died in 2019; in 2020, this escalated to 1,113 mothers with 5,650 infants; death of 972 mothers and 6,453 newborns were recorded in 2021; and 440 mothers as well as 3,355 neonates died at birth till July this year.

Md Shamsul Haque, line director (maternal, newborn, child and adolescent health) at the DGHS told Prothom Alo, the rate of corona transmission was the highest in 2020 and 2021. At that time, maternal and child care had been disrupted across the whole world. The condition has been improving quite a bit this year.

With the aim of achieving Sustainable Development Goals (SDG), the government is taking further steps to ensure pregnant women receiving medical care at health centres, pre-delivery care and safe delivery as well as a reduction in neonatal deaths.

A Special Care Newborn Unit (SCANU) has been established in 44 districts. This facility will be extended in phases to the remaining districts as well, he added.

According to the Bangladesh Bureau of Statistics' ‘Report on Bangladesh Sample Vital Statistics 2020’, maternal mortality in every 100 thousand births in the country is 163 while, neonatal mortality is 15 per thousand.

Whereas according to Bangladesh Maternal Mortality and Health Care Survey (BMMS) 2016, done by National Institute of Population Research and Training (NIPORT), 196 mothers die in the country while giving birth to every 100 hundred children.

Maternal death is defined as death of a mother during pregnancy or within 42 days after delivery. And, a child is considered a neonate for 28 days from birth.

Maternal and neonatal health risks

Asia Akhter, a resident of capital’s Shantibagh area, gave birth to a baby girl through surgery at Dhaka Medical College Hospital on last 31st May. This is her firstborn child. While talking to Prothom Alo on the hospital corridor, Ayesha Akhter, sister of Asia Akhter said, both her sister and the newborn were unwell.

Her health deteriorated trying to give birth at home with the help of a midwife. When the midwife failed to induce the delivery, Asia was taken to a local clinic. But, the clinic didn’t keep her admitted there because of her critical condition. Later, she was brought to Dhaka Medical College Hospital.

Ayesha also said, the child defecated inside the womb and consumed it due to the delayed delivery. Physicians have advised admitting the infant to Newborn Intensive Care Unit (NICU). However, the family couldn’t admit her there, being unable to find any vacant bed.

Hospital sources say that there are only 42 beds at the NICU of Dhaka Medical College Hospital. In front of the NICU and neonatal ward (211 no.) of DMCH on 31 May, many worried parents were seen submitting applications, hoping to admit their infants at the NICU.

Coming from Keraniganj, a mother named Rehana Akhter admitted her five-day old child at the NICU on 14 May. With tears in her eyes, this mother told Prothom Alo, her son weighs only 1.5 kilograms and suffers from shortness of breath.

She managed to find a bed at the NICU after keeping her child at a private hospital for five days following birth. She has two other children and has suffered miscarriages twice.

When contacted on 29 August, Md Islam, the father of the child said they have lost that child. He said they took the infant home towards mid-June when he had recovered a bit.

The child fell sick again after 15 days and they took him to ‘Mohammadpur Fertility Services and Training Centre and 100-bed Mother and Child Health Hospital’.

From there, he was referred to Bangladesh Shishu Hospital and Institute. Finding no ICU bed available there, they admitted the infant to the general ward, where he died on 11 July.

Md Ashraful Alam, acting deputy director of Dhaka Medical College Hospital told Prothom Alo, the expectant mothers that come to DMCH in a critical condition. And 90 per cent of the mothers are actually transferred from other hospitals. For these reasons, maternal and neonatal death rates are comparatively high at the tertiary level (third tier) government hospitals, he added.

Ashraful Alam further said, pregnancy is a long phase. Therefore, the negative impact on maternal and child health during the high corona transmission period of 2020 continued into 2021 as well.

The healthcare had been corona-centric in these two years and the focus on maternal and neonatal care had been less in comparison. Many mothers didn’t take proper pre-birth and post-birth care either, he noted.

As per DGHS data, compared to 2019, there were 18 per cent less deliveries in 2020 and 10 per cent less deliveries in 2021. A total of 235,228 children were born in the first seven months of the current year.

When counted on average per day, the delivery rate till July this year is 4 per cent less than that of 2019. However, it is respectively 15 and 6 per cent more in comparison to 2020 and 2021.

Most deaths are preventable

Professor Manisha Banerjee, head of the neonatology department of Dhaka Medical College Hospital, told Prothom Alo that most neonatal deaths are in fact preventable. Many children are born premature and with low birth weight.

She added, many infants suffer from respiratory problems at birth. If unable to breathe properly for any reason, oxygen supply to the body including the brain stops. Many children are born with birth disabilities and those children face high mortality risk. Safe delivery is vital for this.

Manisha Banerjee also said that whoever delivers a child must ensure cleanliness. A mother has to take regular antenatal care and eat nutritious food for a healthy child. Extra care has to be taken so that the infant does not contract any infection at birth. Taking these measures can prevent neonatal deaths.

Data from Dhaka Medical College Hospital state, where an average of 31 newborns died per month in four months from January to April of this year, the average number was 32 in the first four months of 2021.

When asked about the lack of healthcare to prevent neonatal deaths, Manisha Banerjee said, the government is moving ahead with many goals to prevent this. However, the healthcare system needs to be improved even more.

Infection spreads from one child to another so rapidly that it is impossible to accommodate two or three newborns on the same bed. Each infant requires a bed of its own. Increasing NICU, SCANU and Kangaroo Mother Care facilities in every government hospital is essential, she added.

As per BMSS survey 2016, as much as 54 per cent of maternal deaths during childbirth are caused by excessive bleeding and convulsions.

Professor Ferdousi Begum, president of Obstetrical and Gynecological Society of Bangladesh (OGSB), an association of specialist gynecologists and obstetricians commented, most maternal deaths can be averted if proper health care is ensured.

She told Prothom Alo, even now 50 per cent of births in the country usually take place at home.

Awareness has to be raised among people to go to the healthcare centres for availing maternal care. Plus, the healthcare centres have to be modernized and made better suited to facilitate expecting mothers.

It is essential for medical care to be available 24 hours a day to facilitate pregnant women. However, many union and upazila-level health care centres in the country don’t even have physicians or midwives, she said.

Ferdousi Begum further added that maternal mortality rate in the country is still significantly high. Without taking adequate steps in the health sector, it will be difficult to slash maternal mortality to 70 per 100 thousand live births by 2030, as per the Sustainable Development Goals (SDG).

*This report appeared in the print and online edition of Prothom Alo and has been rewritten in English by Nourin Ahmed Monisha