Pregnancy and childbirth are exciting and challenging periods in a woman’s life that require extra care and support even in the best of circumstances. While women are not shown to be at increased risk of getting COVID-19, pregnant women (and those will be become pregnant during the pandemic) are significantly affected by the disruptions brought to the health care system by the need for social distancing and isolation, overburdened health facilities and services, decreased number of contacts and quality of care visits, increased anxiety and confusion, contradictory messages and recommendations, and even increased home births without properly skilled birth attendants.
Women and adolescent girls also have special physiological and social and emotional needs, which they will experience even more direly during stressful times with constraints in the food supply and household reserves. The nutritional and dietary restrictions during a pandemic put them at higher risk of developing anaemia, micronutrient deficiencies and other forms of undernutrition, compromising their immune system and ability to fight off illnesses – and, for expecting mothers, increasing pregnancy and childbirth-related complications.
During the pandemic, ensuring continued access to quality antenatal care (ANC), and care during delivery, is deemed as “essential and high priority” by the World Health Organization. Therefore, as countries do their best to protect and provide essential health services for their most vulnerable citizens, it will be important to continue to advocate for access and quality care for pregnant women, particularly in low– and middle–income countries. We should recognize that under special circumstances, ANC will need to be adapted, and packages of care will need to be developed that can be realistically delivered to homes during disruptions to routine services. This will require task–shifting and enhancing and increasing home-based service support by appropriately trained community health workers and informal care givers. Getting creative with delivery modalities, such as virtual or mobile platforms for ANC contacts whenever possible to ensure access to information and counselling, can be a first step.
It will be imperative to strengthen supply chains to ensure an uninterrupted supply of micronutrient supplements (iron-folic acid, or IFA, or Multiple Micronutrient Supplements, or MMS), and the flexibility to respond to a potential need for health workers to distribute larger quantities to women to last through periods of decreased access to ANC. During the pandemic, MMS could help fill a known gap in micronutrient deficiencies and provide additional health benefits compared to IFA for both mother and baby such as additional risk reduction of babies born too soon and too small. Furthermore, ensuring newborns’ continued right to skin-to-skin contact, timely-initiation of breastfeeding, exclusive breastfeeding, and preventing the inappropriate marketing of breastmilk substitutes remains of utmost importance. Optimal breastfeeding support should be continued for all pregnant women and mothers with infants and young children, whether they or their infants and young children have suspected or confirmed COVID-19.
As an expert ally to governments in identifying best solutions and implementing them effectively at scale, Nutrition International is committed to supporting countries in ensuring proven nutrition interventions for women and children. Considering the challenges posed by the pandemic, we will continue exploring innovative solutions with partners and governments to support healthy pregnancies, birth and maternal outcomes. For example, we will be looking at options for ensuring longer-term, reliable, and adequate supply of maternal supplementation during the lockdown phase, as well as access to evidence–informed messages, including around birth preparedness, breastfeeding and nutrition. Recognizing that a one-size fits all approach is not the answer, Nutrition International is undertaking landscaping exercises, including using its new MMS Cost-Benefit tool to run analyses on the added health benefits of switching to MMS during the pandemic across different countries in Africa and Asia, to empower best decisions under specific health system contexts and burdens of transmission.
Government leadership and strong partner support and coordination is essential to support the rights of pregnant women and newborn babies as they face increased risks due to COVID-19 related challenges. Such an unprecedented time requires efficient problem-solving and enhanced − sometimes non-traditional − partnerships to ensure focus on countries’ most vulnerable populations is not lost. Ensuring governments can make evidence-informed decisions without losing sight of non-COVID-19-related health concerns will require clear, united support from the global health nutrition community. Finding ways to continue to support women and girls to reduce risk of an inadvertent increase in maternal and neonatal mortality and/or morbidity within strained health care and social systems must remain a top priority.