Prenatal services at the clinic were free, but the price of the motorcycle taxi was more expensive than Monica Maxwell could afford. Just four weeks before giving birth, she concocted 1,400 kwacha ($ 1.75) for the 50-kilometer (31-mile) round trip. This was only her third visit, less than her first two pregnancies. The money she made selling tomatoes has dried up amid the pandemic. Her husband’s income from selling meat also declined.
“It was the most difficult time of our life. We didn’t have the money for our daily survival,” said Maxwell, 31. “Most of the time we stayed at home.
In a country where hospitals are so bare that women are expected to bring their own razor blades to cut umbilical cords, the worsening poverty caused by COVID-19 puts women’s lives at greater risk.
Authorities say far fewer pregnant women in Malawi are receiving the health care they need amid the pandemic, many forgoing medical visits and relying solely on traditional birth attendants, who provide emotional support and administer basic treatment. of plants but are prohibited by the government from giving birth because they lack formal training. Many families cannot afford clinic visits or transportation; they are also worried about catching the coronavirus in hospitals.
The gains that Malawi – a largely rural part of a country with 18 million people – has made over the past decade to tackle its dismal maternal death toll are under threat. According to the United Nations Population Fund, Malawian women are at one in 29 risk of death from pregnancy or childbirth.
The country has 439 such deaths per 100,000 live births – a number it strived to reduce to 984 per 100,000 in 2004. Yet Malawi’s rate is the third highest in southern Africa.
This story is part of a year-long series on the impact of the pandemic on women in Africa, especially in the least developed countries. The AP series is funded by the European Development Journalism Grants program of the European Journalism Center, which is supported by the Bill & Melinda Gates Foundation. AP is responsible for all content.
Hospitals also suffered from a staffing shortage when nurses were mobilized to treat coronavirus patients, which resulted in a shortage of experienced staff for deliveries, said Young Hong, of the United Nations Health Fund. population.
“Not only has the pandemic affected the availability of manpower, it has also put great pressure on the entire health system, including the out of stock of some drugs, equipment, basic medical supplies.” said Hong, who noted that eight Malawian women die of pregnancy daily. complications, higher than the COVID-19 toll. “It had a huge impact on the quality of maternal health services. “
At the Ndirande health center, northeast of the country’s commercial capital, Blantyre, around 100 pregnant women visited daily before the pandemic. That number is now 15 to 20, said Jacqueline Kolove, clinical nurse.
Sometimes even women who come for antenatal care are afraid to give birth in the clinic, preferring their home. Malawian women are encouraged to give birth without medical intervention; many think emergency measures are shameful. Giving birth at home, however, can be fatal if complications arise – most women live far from clinics.
“We explain to them why such a decision could have dire consequences … sometimes even calling their husbands and parents to try to reason with them,” Kolove said.
In Ndirande and other clinics, nurses, orderlies and midwives perform ultrasounds on pregnant women and use equipment to monitor mother and baby. The woman can have caesarean sections if necessary; medicines are available to stop severe bleeding. Staff attend classes, observe mock births and obtain a license.
Traditional birth attendants learn from the elderly who pass their knowledge down from generation to generation and use little or no medical equipment – they listen to women’s bellies by placing their ears there, for example, and collect herbs to induce labor.
Malawi banned delivery of birth attendants in 2007, but the practice continues; the ban is rarely enforced. Attendants like Lucy Mbewe, 56, don’t charge anything. She says her job is essential for women who can’t afford anything else.
Even the colorful African fabric used to wrap babies, carry them on mothers’ backs or create makeshift diapers can be a potential obstacle, Mbewe noted. “Hospitals recommend that a woman who is going to give birth needs to take at least 10 pieces of tissue with her, which is a deterrent for those who cannot even afford to put food on the table,” a- she declared.
Women are even expected to bring bed covers, buckets of water, and sometimes candles or flashlights. Mbewe provides clothes and soap when helping women give birth. She pays for transportation. Some women reimburse it; she uses that money for other clients, she says.
Trained midwives say the use of assistants has increased complicated deliveries. Mbewe says the complications are attributable to pregnant women 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. Malawi has seen an increase in coronavirus cases, part of an increase in southern Africa.
The government of Malawi has administered less than 213,000 doses of the AstraZeneca vaccine. Authorities destroyed around 20,000 expired doses provided by COVAX, the UN-backed program to ship vaccines to poor countries. In Africa, only 1% of the population received a dose, according to the African Centers for Disease Control and Prevention.
Nurses and midwives say some women fear secretly receiving vaccines.
“They feel, as health workers, that we are giving them the COVID-19 vaccine instead of oxytocin,” Nursing Sister Kolove said, referring to a drug that strengthens contractions and reduces the risk of bleeding. “They feel like we are cheating on them.”
Medical staff also understand the higher risks of contracting the coronavirus. The staff try to educate the women and take every precaution, even if their work makes it impossible to maintain physical distance, said Keith Lipato of the Malawi Association of Midwives.
“We make sure that all midwives are screened and tested so that those who show signs and symptoms are relieved of work and receive the necessary medical treatment,” said Lipato.
Lipato and others fear the pandemic will have lasting effects on women’s health.
Patricia Gunde, 26, did not receive antenatal services during her first pregnancy. She prefers the herbs of her servants. Gunde has no plans to get the vaccine.
“I’m scared,” she said. “I have heard a lot of stories about this.”
With the birth attendant, she feels comfortable because the women are seen one by one.
When the attendant brings Gunde to treatment, neither of them is wearing a mask.
AP writers Krista Larson in Dakar, Senegal, and Andrew Meldrum in Johannesburg contributed.