Adequate maternal care during pregnancy, childbirth and the postpartum period is essential to curbing the high maternal mortality rates in Latin America, which stopped falling due to women's health care problems during the COVID pandemic. CREDIT: Government of Tigre / Argentina

By Mario Osava
RIO DE JANEIRO, May 27 2022 (IPS)

Brazil had the dubious distinction of champion of maternal mortality in Latin America during the COVID-19 pandemic, with a 77 percent increase in such deaths between 2019 and 2021.

A total of 1,575 women died in childbirth or in the following six weeks in the year prior to the pandemic in Latin America’s largest and most populous country, with a population of 214 million. Two years later the total had climbed to 2,787, according to preliminary data from the Health Ministry’s Mortality Information System.

In Mexico, the second-most populated country in the region, with 129 million inhabitants, the increase was 49 percent, to 1,036 maternal deaths in 2021. And in Peru, a country of 33 million people, the total rose by 63 percent to 493 maternal deaths.

In Colombia, recent data are not available. But authorities acknowledge that in 2021 COVID-19 became the leading cause of maternal deaths, as it was in Mexico.

Brazil is the extreme example of multiple mistakes and of stubborn denialism that led to many avoidable deaths, particularly of pregnant women, according to experts and women’s rights activists on the occasion of the International Day of Action for Women’s Health, celebrated May 28.

In Latin America maternal mortality remains a major problem.

The Pan American Health Organization (PAHO), the regional office of the World Health Organization (WHO), states that “maternal mortality is unacceptably high” and that they are “mostly preventable” deaths, which especially affect pregnant women in rural areas.

These levels, the agency adds, will delay reaching target 3.1 of the 17 Sustainable Development Goals (SDGs): to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030.

A woman takes part in a care program for pregnant women in a low-income area of the northern state of Pará, Brazil. PAHO warned that the disruption of health services caused by COVID drove up maternal mortality rates in Latin America and the Caribbean. CREDIT: UNFPA

Something smells rotten

“Inadequate prenatal and obstetric care,” largely due to inadequate medical training in these areas, is the cause of the tragedy in Brazil, said physician and epidemiologist Daphne Rattner, a professor at the University of Brasilia and president of the Network for the Humanization of Childbirth.

“Hypertensive syndrome is the main cause of death in Brazil, while in the world it is hemorrhage. In other words, there is some failure in a simple diagnosis like hypertension and in managing it during pregnancy and childbirth,” she said in an interview with IPS from Brasilia.

Of the 38,919 maternal deaths between 1996 and 2018 in Brazil, 8,186 were due to hypertension and 5,160 to hemorrhage, according to a Health Ministry report. These are direct obstetric causes, which accounted for just over two-thirds of the deaths. The rest had indirect causes, pre-existing conditions that complicate childbirth, such as diabetes, cancer or heart disease.

An excess of cesarean sections is another factor in mortality. It is “an epidemic” of 1.6 million operations per year, the Health Ministry acknowledges. This is equivalent to about 56 percent of the total number of deliveries. The proportion reaches 85 percent in private hospitals and stands at 40 percent in public services, well above the 10 percent rate recommended by the WHO.

“They don’t practice obstetrics, they practice surgery, they don’t know how to provide clinical care, and the result is more maternal deaths,” Rattner lamented.

And the pandemic made the situation more tragic.

Black women protest to demand respect for their rights in Brazil. Black women are the greatest victims of maternal mortality caused by COVID-19 in the country. They account for almost twice the number of deaths of white mothers, according to a study by the Oswaldo Cruz Foundation, the leading national health research institution. CREDIT: Fernando Frazão / Agência Brasil

The stork doesn’t come anymore

Brazil missed the target of reducing maternal mortality by 75 percent by 2015, from 1990 levels, but it was moving in that direction. The maternal mortality ratio (MMR) per 100,000 live births in the country fell from 143 to 60, a 58 percent drop.

The Stork Network, a government strategy adopted in 2011 to improve assistance to pregnant women and the infrastructure of maternity hospitals, humanize childbirth, ensure family planning and better care for children, helped bring the MMR down.

But COVID-19 and the government’s response to it caused a setback of at least two decades in Brazil’s maternal mortality rate.

Coronavirus killed more than 2,000 pregnant and postpartum women in the last two years and there are at least 383 other deaths from severe acute respiratory syndrome that may have been caused by COVID-19, according to the Feminist Health Network, an activist movement that has been fighting for sexual and reproductive rights since 1991.

The way the government of far-right President Jair Bolsonaro acted “was a maternal genocide, not just a disaster,” said Vania Nequer Soares, a nurse with a PhD in public health who is a member of the Feminist Health Network.

The government’s denialism and its response to the pandemic aggravated mortality in general, which already exceeds 666,000 deaths, as well as maternal mortality. Health authorities took more than a year to recognize that pregnant women were a high-risk group for COVID-19, made it difficult for them to receive intensive care and delayed their vaccination, Soares said.

To make matters worse, they decided to dismantle the Stork Network, whose public policies had promising results, and adopted new rules of “obstetric violence” included in the brand new Maternal and Child Care Network (Rami), which concentrates all power in doctors and hospitals, to the detriment of other actors and dialogue, she told IPS by telephone from Lisbon.

Miriam Toaquiza, a teenage mother, and her newborn daughter, Jennifer, are photographed at a hospital in Ecuador. Latin America is second in the world in teen pregnancy, one of the causes of the high maternal mortality rates in the region. CREDIT: Gonzalo Ortiz/IPS

Undernotification and negligence

But the numbers of maternal deaths are probably higher. Brazil was slow to begin using COVID-19 diagnostic tests and did not test widely. And because clinical identification of the new disease was doubtful, many mothers probably died without the correct diagnosis, especially in the first year of the pandemic, Rattner argued.

A study published this month in the scientific journal The Lancet Regional Health – Americas, with accounts from the families of 25 pregnant women who died of COVID-19, revealed three practices that condemned many women to death on the verge of childbirth.

First, doctors refused to hospitalize or better examine those who complained, for example, of difficulty breathing. They attributed it to late pregnancy and delayed a diagnosis that could have saved at least one life.

In other cases, health centers turned away pregnant women because they were dedicated to the COVID-19 emergency, arguing that they could not accept pregnant women because of the risk of infecting them. And in maternity wards, pregnant women were turned away because of the risk that they could bring in coronavirus and affect other women.

Finally, pregnant women who managed to be accepted in hospitals were denied intensive care, under the argument of protecting the baby’s life. In other words, the choice was made to save the child, to the detriment of the mothers, without consulting the families.

This was confirmed by the fact that all 25 pregnant women died, but 19 babies survived. Four families told the health professionals that they wanted the mother to be saved, even arguing that she could have other children in the future, but this proved to be in vain.

The study by three researchers from the Anis Institute of Bioethics, Human Rights and Gender, based in Brasilia, corroborates the complaint of the Feminist Health Network that 20 percent of the pregnant and postpartum women did not have access to intensive care and 32.3 percent were not put on ventilators.

Women must be given protagonism, so that “they can take ownership of the process of motherhood, including childbirth,” said Ligia Cardieri, a sociologist who is executive coordinator of the Feminist Health Network.

Fewer mechanical interventions, a reduction of c-sections that increase risks, including anesthetics, and greater involvement of nurses and other maternal health actors are other recommendations to avoid so many maternal deaths, she told IPS from Curitiba, capital of the southern state of Paraná.

In other Latin American countries, pregnant women with COVID-19 suffered a similar lack of attention and problems.

Nearly a third of them were not given intensive care or respiratory support during the pandemic, revealed a study of 447 pregnant women from eight countries, including five from South America, two from Central America and one from the Caribbean, according to PAHO data.

The study, published in The Lancet Regional Health – Americas, is from PAHO’s Latin American Center for Perinatology/Women’s Health and Reproductive Health (CLAP/WR).

An estimated 36 percent of Papua New Guinea’s eight million people are currently living on less than 1.25 dollars a day. Credit: Catherine Wilson/IPS

By Neena Bhandari
SYDNEY, May 25 2015 (IPS)

As Papua New Guinea celebrates 40 years of independence, 2015 marks a defining year for the largest Pacific Island nation, set to record 15 percent GDP growth this year.

However, unless the government tightens up its policies, the country will likely fail to achieve any of the United Nations’ Millennium Development Goals (MDGs) despite making significant progress in the past few years.

"We believe that if we continue to invest in the programmes that we have today, we will achieve [the] results that the international community has laid down for everybody." -- Peter O’Neill, Prime Minister of Papua New Guinea
“Even with 14 years of successive double digit growth, the challenge for PNG is to translate high levels of resource revenue into well-being for all citizens. The latest estimate of the population is now over eight million and approximately 36 percent of the people are living on less than 1.25 dollars a day,” United Nations Resident Coordinator in Papua New Guinea Roy Trivedy told IPS.

Mineral resources, including copper, gold, oil, nickel, cobalt and liquid natural gas, constitute 70 percent of all PNG exports; and mine and oil production revenues since independence have amounted to 60 billion dollars, according to the Human Development Report 2013.

Still, PNG currently ranks 156^th out of 187 countries in the United Nations’ Human Development Index (HDI).

U.N. agencies have worked across different sectors to support PNG in the development of education and health, poverty reduction, and assistance with disaster risk reduction and social protection. Many of the reforms implemented by the current government over the past three years are beginning to take root.

For example, the Tuition Fee Free (TFF) education policy, benefitting students at the elementary and secondary level, is gaining acceptance throughout the country, with two million children currently enrolled in schools.

The government is also investing in higher education and vocational and tertiary education. But the country faces the challenges of tackling high student-to-teacher ratios, building and refurbishing educational infrastructure, improving quality of primary education services and scaling up the provision of secondary and tertiary education.

The government has also committed to free primary health care for all citizens, but U.N. agencies working in PNG say more needs to be done to reduce the infant mortality rate from the current 75 deaths per 1,000 live births; reduce the number of under-five children dying of preventable diseases; and reduce the maternal mortality rate, which has remained at 733 deaths per 100,000 live births over the past decade.

In addition, early childhood health is a major issue, with 48 percent of children aged five or younger suffering from malnutrition.

Infrastructure development will also be crucial to realising the benefits of the country’s mineral, energy, agricultural and tourism assets. The government is spending considerable resources to modernise and better equip the police, judiciary and corrective services critical for tackling inequality and discrimination, especially against women.

PNG will have an opportunity to demonstrate its commitment to uplifting the lives of its people as the international community moves into a new phase of its development agenda: the post-2015 Sustainable Development Goals (SDGs).

Papua New Guinea is the co-facilitator with Denmark of the Global Summit on SDGs scheduled to take place later this year.

Following a decade-and-a-half of development guided by the Millennium Development Goals (MDGs), the new global blueprint for poverty eradication is expected to be centred on sustainability, including combating climate change, protecting the environment, preserving biodiversity and conserving oceans, seas and marine resources: issues that are highly relevant for Pacific Island countries threatened by rising sea levels.

While the 22 Pacific island countries and territories contribute just 0.03 percent to global emissions, their collective population of 10 million people will likely suffer some of the worst impacts of climate change.

In addition to loss of human life as a result of natural disasters, the Asian Development Bank (ADB) estimates that climate change could cost the region over 12 percent of its annual gross domestic product (GDP) by the turn of the century.

Against this backdrop, IPS correspondent Neena Bhandari sat down with Papua New Guinea’s Prime Minister Peter O’Neill, to discuss the U.N.’s role in PNG’s development agenda. Excerpts from the interview follow.

Q: Has the United Nations contributed to Papua New Guinea’s economic development?

A: We have many United Nations organisations in Papua New Guinea and I would like to thank them for their contribution to the country’s development agenda. We are very happy with the work that they are doing, especially UNDP [the United Nations Development Programme], which is engaged with our department of planning [Department of National Planning and Monitoring] in setting up various programmes all around the country, including Bougainville.

Q: It seems PNG is not ‘on track’ to meet any of the Millennium Development Goals, scoring either ‘off track’ or ‘mixed’ in the latest results surveys. What is being done to fix the problem?

A: In fact, we have made significant progress in meeting the Millennium Development Goals. Two or three years ago, we would have completely missed the MDG targets. But right now on issues related to infant mortality and literacy, the progress is much better because of the education and health programmes that we are rolling out. These programmes are contributing significantly to meeting the MDG targets.

Q: What are your aspirations for the Sustainable Development Goals? What strategies would you adopt to achieve the SDGs?

A: We think that our policies today are starting to yield the positive outcomes that we want: to make sure our literacy rates are beyond 80 to 90 percent; our infant mortality rates drop down to levels that are comparable to our neighbouring countries; and our life expectancy increases. We believe that if we continue to invest in the programmes that we have today, we will achieve those results that the international community has laid down for everybody.

Q: The island nation has been the focus of Chinese investment and Australian aid. The Australia-PNG bilateral aid programme is worth approximately 577 million dollars in the current financial year. Which has been more beneficial for the country’s development?

A: Both are beneficial. The Chinese investment is not dissimilar to many of the other investments they make around the region. They make similar investments in Australia, similar investments in Indonesia and all throughout the world. But I think in terms of support in social programmes, the more beneficial investment is through the aid programme that the Australian Government continues to provide.

Now they are aligning their programmes to our priorities, which has never happened before. The aid programme is now looking towards the education problems that we have, the health, good governance and the law and order problems that we have. Those are the programmes that our government is regularly focusing on and the aid programme is partnering in achieving the outcomes that we want.

Q: In Papua New Guinea, there have been positive steps toward integrating West Papuan refugees and also lifting reservations to the 1951 Refugee Convention. What measures are being taken to rehabilitate ‘climate refugees’, for example, people residing on Carteret Islands, who are in danger of being submerged due to the rise in sea levels?

A: Climate change is global and it is not something that is unique to PNG, but we are trying to resettle many of those refugees on the mainland. Most of them have families and we are trying to get them integrated into communities that they are comfortable with. As in the case of West Papuan refugees down at Western Province, many of them are already in PNG for many, many years and we are taking steps so they can become citizens and have access to all the services that the government provides for its citizens.

Q: Will climate change be a major problem for PNG and other countries in the Pacific?

A: Yes, we are facing similar problems like some of the smaller Pacific Island countries. We have thousands of low-lying islands and as the sea level rises, these people will have to continue to move. The first step for developed countries like Australia and the United States should be to sign up to the Kyoto Protocol and then go with the rest of the international community. Climate change is a global issue where we all need to work together in reducing emissions and lowering the global warming challenge that we face.

Edited by Kanya D’Almeida

Excerpt:

A woman remains pensive during a support group meeting for families of missing persons in the south-eastern Nepali town of Biratnagar. Credit: Amantha Perera/IPS

By Renu Kshetry
KATHMANDU, Apr 7 2015 (IPS)

Kali Sunar, 25, a resident of the Dumpada village in the remote Humla District in Far-West Nepal, lives a life that mirrors millions of her contemporaries.

From the minute she rises early in the morning until she finally rests her head at night, this rural woman’s chief concern is how to meet her family’s basic, daily needs.

"Women leaders have to rise above party lines if they really want to make a difference." -- Usha Kala Rai, a leader of the ruling Communist Party of Nepal (Unified Marxist Leninist)
Her small plot of arable land scarcely produces enough food to feed her family of six for three months out of the year. With few other options open to them, her husband and her brother travel to neighbouring India to work as labourers, like scores of others in this landlocked country of 27.5 million people.

“The money they send is not enough because more than half of it is spent on their travel back and forth,” Sunar tells IPS. “If only I could get some kind of work, it would be a huge relief.”

Roughly 23 million people, accounting for 85 percent of Nepal’s population, live in rural areas. Some 7.4 million of them are women of reproductive age. Many are uneducated – the female literacy rate is 57.4 percent, compared to 75 percent for men – and while this represents progress, experts say that until women in Nepal gain equal footing with their male counterparts, the lives of women like Sunar will remain stuck in a rut.

Nepal has signed a string of international treaties that promise gender parity – but many of these pledges have remained confined to the paper on which they were written.

The Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), which Nepal ratified in 1991, specifies for instance that states parties must take all necessary steps to prevent the exclusion of, or violence towards, women; sadly, this has not been a reality.

According to the Kathmandu-based Violence Against Women (VAW) Hackathon, an initiative to provide support to victims of abuse, gender-based violence is the leading cause of death among Nepali women aged 19 to 44 years – more than war, cancer or car accidents.

The organisation further estimates: “22 percent of women aged 15 to 49 have experienced physical violence at least once since age 15; 43 percent of women have experienced sexual harassment in the workplace; [and] between 5,000 and 12,000 girls and women are trafficked every year.”

Some 75 percent of these girls are under 18; the majority of them are sold into forced prostitution.

Rights activists say that the country also routinely flouts its commitment to eliminate gender discrimination in the workplace, in legal matters, and in numerous other civic, economic and social spheres.

Twenty-five-year-old Kali Sunar barely grows enough on her small plot of arable land to feed her family of six for three months out of the year. Credit: Renu Kshetry/IPS

Not only international treaties but domestic mechanisms, too, have failed to pull the brakes on sex discrimination and gender-based inequities.

A 2007 Interim Constitution, designed to ease Nepal’s transition from a constitutional monarchy to a federal republic, made provisions for women – as well as for other marginalised groups like Dalits (lower caste communities) Adivasis (indigenous and tribal groups), Madhesis (residents of the southern plains) and poor farmers and labourers – to be active political participants based on the principle of proportional inclusive representation.

These were all steps in the right direction, bolstered by the 2008 election of the Constituent Assembly (CA), which saw women occupying 33 percent of all seats in the 601-member parliament.

However, that number fell to 30 percent in the second election, held in 2013, the first after the CA failed to draft a new constitution. With only 11.53 percent of women in the cabinet, experts say there is an urgent need to increase the number of women at the decision-making level.

According to a monitoring report by the non-governmental organisation Saathi, which tracked progress on United Nations Security Council Resolution 1325 (UNSCR 1325) relating to women, peace and security, women’s participation in Nepal’s judiciary stands at an average of 2.3 percent, with 5.6 percent of women in the Supreme Court, 3.7 percent in the appellate courts, none in the special courts and 0.89 in the district courts.

Women’s representation in security agencies is even more worrisome, according to a 2012 study entitled ‘Changes in Nepalese Civil Services after the Adoption of Inclusive Policy and Reform Measures’: there are only 1.6 percent women in Nepal’s army, 3.7 percent in the armed police force and 5.7 percent in the regular police force.

Dismal numbers of female civil servants across a broad spectrum of service groups also spell trouble: women account for just 9.3 percent of civil servants in the education sector, 4.4 percent in the economic planning and statistics division, 4.9 percent in agricultural affairs, 2.2 percent in engineering and two percent in forestry.

Only in the health sector do women come anywhere close to their male counterparts, with 4,887 out of 13,936 positions, roughly 36 percent, occupied by women.

Still, even this number is low, considering the health indicators for women that could be improved by boosting women’s representation at higher levels of politics and government: according to the World Health Organisation (WHO), Nepal has a maternal mortality ratio (MMR) of 190 deaths per 100,000 live births. Only 15 percent of Nepali women have access to healthcare facilities.

Data from Nepal’s Central Bureau of Statistics (CBS) indicate that only 19.71 percent of all families exercise female ownership of land or housing, another reason why women continue to languish on the lowest rung of the social ladder with little ability to exercise their own independence.

Although Nepal’s female labour force participation rate is higher than many of its South Asian neighbours – 80 percent, compared to 36 percent in Bangladesh, 27 percent in India, 32 percent in Sri Lanka and 24 percent in Pakistan, according to the International Labour Oragnisation (ILO) – working women are burdened by social attitudes, which dictate that women undertake domestic labour as well as their other jobs.

“This makes it difficult for women to perform [in their chosen field] and have an impact,” explains Mahalaxmi Aryal, a member of the CA from the Nepali Congress.

Usha Kala Rai, a prominent women’s rights activist and politician, admits that the country has many legal grounds on which to address women’s issues, but says they are seldom utilised to their best effect.

“We completely lack the political will and the commitment to implement these legal provisions,” says Rai, a former member of the Constituent Assembly and leader of the ruling Communist Party of Nepal (Unified Marxist Leninist).

She calls for increased numbers of women in decision-making roles, but acknowledges that those who make it to the top generally come from the elite class, with the added privilege of having received a good education – thus they are not necessarily representative of women across the socio-economic spectrum.

She tells IPS she favours a system of proportional representation for all state bodies on the basis of the female share of Nepal’s population – 52 percent.

“Women leaders have to rise above party lines if they really want to make a difference,” she explains, citing the creation of the 2008 Women’s Caucus, comprised of all 197 women in the Constituent Assembly representing every major political party, to stand together for women’s rights irrespective of ideology.

However, pressure from male leaders meant that the second Constituent Assembly was unable to revive the Caucus, with the result that women no longer have a unified platform on which to voice their collective demands.

“Women politicians have been handpicked by their parties under the proportional representation (PR) [system], which makes them vulnerable to partisan politics,” political science professor Mukta Singh Lama tells IPS.

Until such a system is replaced with one that prioritises genuine inclusion of women at every level of the state, experts fear that Nepal’s women will not have an equal hand in the shaping of this country.

Edited by Kanya D’Almeida