Millions of pregnant women face a heightened risk of dying in childbirth as rising fuel costs and the fallout of global wars cut them off from life-saving care, maternal health leaders have warned.
In recent months, hundreds of mothers have been dying every day in the inhumane conditions of crisis-hit countries including Gaza, Ukraine and Sudan.
Now, the US-Israel war on Iran has opened up new fronts and sent transport prices up — cutting thousands more women off from essential maternity care, the International Confederation of Midwives (ICM) told the Mail & Guardian on Thursday.
“No woman should face labour without a midwife,” said Neha Mankani, of ICM’s Humanitarian Taskforce. “But as fuel prices rise, the cost of transport has started to increase, making it harder for women to physically reach a health facility when they need care or for midwives to reach them.”
The delay in accessing care could be the difference between life and death, she said. “When women cannot reach care in time — or when midwives cannot reach them — complications during childbirth can quickly become fatal. These are preventable deaths.”
Sub-Saharan Africa bears the brunt of the global maternal mortality crisis, accounting for about 70% of maternal deaths worldwide — about 182 000 a year, or roughly 500 a day. Nine of the 10 worst-hit countries globally are on the continent.
South Africa is considered significantly safer, with 118 deaths per 100 000 live births, far lower than the global average of 197.
But campaigners argue that every mother lost is one too many and quality of care has been found lacking in South Africa. Last month, the M&G reported how 60% of women giving birth in KwaZulu-Natal and Gauteng over the past decade have experienced some form of obstetric violence.
South Africa’s mothers also face fears over the risk of going into labour at a time when fuel may be scarce or cripplingly expensive. On April 1, petrol prices climbed by R3.06 a litre, with the government cushioning the increase by cutting the general fuel levy by R3/litre for the month.
The disruptions have escalated since February 28, when US and Israeli strikes on Iran triggered retaliatory action that shut the Strait of Hormuz to normal commercial traffic.
About 20% of the world’s oil and gas passes through the Strait of Hormuz, meaning the disruption has sent shockwaves through global energy markets and compounded the crisis for vulnerable populations, including pregnant women and mothers.
Across Africa, the strain is being felt. “Fuel shocks don’t just affect transport,” added Mankani. “They can disrupt the entire health system. Ambulances may not run, facilities may lose power needed to store blood and essential medicines.
“Women in conflict settings already face enormous barriers to care. This escalation risks deepening those barriers at the most critical moment in their lives.”
As US-Israeli fighting with Iran spreads across the region, women have been giving birth in displacement camps, bombed-out facilities or alone without support.
In the past three weeks, 147 000 people have escaped bomb strikes in Lebanon and crossed into neighbouring Syria, where 1.5 million have sought safety.
“Over 2 200 pregnant women and girls are among the new arrivals, with 260 expected to give birth within the next 30 days,” said Enshrah Ahmed, the Syria representative of the United Nations Population Fund (UNFPA).
Concerns have also been voiced at a global summit, where maternal health leaders raised the alarm over dangers in a world where more than 60 active conflicts are under way.
“Conflicts are increasing,” said Dr Rondi Anderson, a midwife adviser who has worked on the frontline in warzones since the 1990s. “We’re at the highest since World War II.
“There are 40 million pregnant women in conflict zones and there’s a 50% reduction in access to reproductive healthcare in acute conflict settings,” said Anderson.
Anderson was speaking at the International Maternal and Newborn Health Conference in Nairobi, Kenya, where 1 800 experts from 87 countries met last week to tackle a polycrisis that includes climate change, funding cuts and widespread breaches of women’s rights.
“It is one of the weapons of war that health systems are targeted,” she added. “Female providers face added gender-based risks and violations.
“Women can get stuck in pockets where they can’t move … There’s supply chain disruptions, there’s limited referral systems and of course the providers have stress.”
In these conditions, even routine complications become fatal.”
The scale of the crisis is reflected in a recent World Health Organisation report, which shows that six in 10 maternal deaths occur in 37 countries affected by conflict or fragility.
For those working on the frontlines, the psychological toll is mounting. “It is staggering the numbers of maternal deaths — and morbidity — connected to crisis and conflicts,” said Anna af Ugglas, the chief executive of the ICM.
“In Ukraine … the constant threat of drones and missiles and threat to life 24/7 has an enormous mental toll on midwives and women’s mental health and this increases the risk of preterm birth.”
The ICM has recently launched its Humanitarian Taskforce to build the capacity of midwives on the ground in crisis-hit regions. “Midwives are running out of energy … The mental health challenge is really the violence — gender-based violence, sexual violence and other violence,” Ugglas added.
Every year, about 260 000 women die as a result of pregnancy and childbirth, 1.9 million babies are stillborn and 2.3 million newborns die in the first month of life. Most of the deaths are preventable.
Global bodies agree that high quality midwife-led care is the way to avert crises for most women and babies.
Last week, authorities backing a “Midwifery Accelerator” for governments to roll out optimal midwifery included Unicef, UNFPA, the International Federation of Gynaecology and Obstetrics and the Johns Hopkins Programme for International Education in Gynaecology and Obstetrics.
UNFPA programmes director Julia Bunting spoke at an event convened with the International Rescue Committee called “Advancing midwifery in humanitarian settings”.
“About 90% of a minimum initial service package can be delivered by midwives,” she said. “If we want midwives to continue saving lives we need to commit to preserving their professional safety. How can we ensure that those who deliver life are never left to stand alone?”
A global maternal health funding hole has been compounded after development aid was slashed in countries like the US and UK last year, as governments diverted money to domestic and military priorities.
As wars disrupt fuel supplies and health systems, more women are being forced to give birth without timely access to skilled care