Since the early days of the Ebola epidemic, women — serving as front-line healthcare workers and caretakers in their communities — have faced the greatest risk of contracting the disease and have died at far higher rates than men. According to UN Women, women account for 75% of Ebola-related fatalities in Liberia and 59% in Sierra Leone.
But those figures only tell part of the story.
The Ebola outbreak in West Africa has also increased maternal mortality and complicated access to pregnancy and postpartum care for women and their newborns. Even those who escape the wrath of the deadly virus still face the grave prospects of enduring pregnancy and childbirth without access to even the most basic, life-saving medical care.
“The reality is that pregnant women are facing a double threat – dying from Ebola and from pregnancy or childbirth, due to the devastating impact of Ebola on health workers and health systems,” said Dr. Babatunde Osotimehin, Executive Director of the United Nations Population Fund. “Ebola is not only killing those infected, but also those affected. Pregnant women and girls are at greater risk.”
Typically, a person who receives prompt treatment for Ebola has about a 40% chance of survival, but among pregnant women and their fetuses, the survival rate can be as low as 5%, one small study found. A pregnant woman is highly likely to transmit the virus to the fetus, often leading to stillbirth or death shortly after birth, according to a recent NPR report.
Further, the risk of infection has discouraged providers from caring for pregnant Ebola patients. Providing care for a pregnant Ebola patient is especially challenging because the virus is present in both the amniotic fluid and the woman’s blood.
When a woman is bleeding, providers often must respond within a relatively short time frame, meaning that a provider could have to decide between saving the woman and fetus or taking the time to put on protective gear. Given the large volume of bodily fluid released during such cases, even providers with access to protective gear run the risk of contracting Ebola.
That’s how American missionary doctor Rick Sacra contracted Ebola in August, NPR points out. Sacra, who received treatment at the Nebraska Medical Center, was helping pregnant women at a hospital outside Monrovia called Eternal Love Winning Africa, or ELWA, when he fell ill with the virus.
What’s more, women who are miscarrying often present with bleeding and cramping, which can appear similar to someone with Ebola. This makes it difficult for doctors to tell the difference, and many are too scared to take the risk.
For a glimpse of the problem, read this anecdote from The Washington Post’s report on how regular medical treatment is being disrupted by Ebola:
As a Washington Post photographer watched one day last week, a woman in labor arrived at the JFK Ebola treatment center in a taxi, sent by workers at the hospital’s recently reopened maternity ward because she had no evidence that she was free of Ebola.
But no one came to the Ebola facility’s gate — and even if someone had, the woman’s chances of gaining entry were next to zero. With no evidence that she had Ebola, the isolation center would not bring her inside among those who have the virus.
Crumbling public health infrastructure
The crisis has also diverted critical resources away from pregnant women, who already faced limited access to adequate health care. For example, in Bong, one of the most populous counties in Liberia, the ambulance used for obstetric emergencies is now being used for the Ebola response. And the surgical and emergency departments at JFK Hospital, one of the country’s major referral hospitals, are closed.
Furthermore, many clinics in Liberia refuse to treat pregnant women, and hospitals have closed their maternity wards. Additionally, many midwives will not care for patients because so many nurses and midwives who have helped pregnant women have died.
“As a result of the outbreak, there has been an increase in pregnant women dying from preventable causes, including antepartum and postpartum hemorrhage, ruptured uterus, as well as hypertensive disease,” Dr. John K. Mulbah, chairman of the obstetrics and gynecology department at the University of Liberia, reported to the United Nations Population Fund.
Ebola is also affecting maternity care in Sierra Leone: birth rates have declined at the hospital in Freetown, the nation’s capital, with more women giving birth at home, where the risks of serious complications and death are far higher. A Doctors Without Borders clinic in Gondama, Sierra Leone, also closed because of the risk of staff becoming infected.
Ebola threatens to reverse gains in maternal health
Liberia and Sierra Leone already have some of the world’s worst maternal and infant death rates though they are better than they were: In 2010, some 890 women in Sierra Leone died per 100,000 live births, down from 2,000 ten years earlier. In Liberia 770 per 100,000 died in 2010, down from 1,100 in 2005, according to UNICEF.
The improvements are linked to the introduction of free health care to pregnant, birthing and lactating women in public health facilities. Both countries had also upped the number of births attended by a health professional to 63 percent in Sierra Leone in 2012, and 46 percent in Liberia.
But when Ebola broke out in Sierra Leone in May, and Liberia in August, the number of births attended by a health professional in Liberia dropped from 52 percent to 38 percent, while the number of women in Sierra Leone attending hospitals and health centers to give birth has dropped by 30 percent, according to the countries’ respective Health Management Information Systems.
“The situation for pregnant women in Ebola crisis countries is devastating. Gains in maternal health and family planning are being wiped out and women are desperate for information and services to protect their health and that of their babies,” said UNFPA’s Dr. Osotimehin.
UNFPA has predicted that tens of thousands of women and their infants could die in the region if maternity wards and other providers do not resume offering services. Furthermore, it has been estimated that 1.2 million women of childbearing age may lack access to the family planning services they require. This will increase the number of unexpected pregnancies in these countries.
According to a recent UNFPA estimate, at least $64.5 million is needed to provide reproductive and maternal health services in the next three months in Guinea, Liberia and Sierra Leone.