That seems to be happening again, says Tim Roberton, an international-health researcher at Johns Hopkins’ public-health school. Back in the spring, Roberton modeled various scenarios of COVID-19 intensity in 118 low- and middle-income countries, and found that the least severe scenario would result in an additional 12,200 maternal deaths over six months. The most severe scenario would kill an additional 56,700 pregnant women—an increase of up to 38.6 percent in maternal deaths per month.
The greater share of these deaths is not associated with actually catching COVID-19. Sixty percent would be attributable to four childbirth interventions—parenteral administration of uterotonics, antibiotics, and anticonvulsants, and clean birth environments. That is, nearly all of those causes of death are preventable with adequate medical care.
Have those models come true? “It’s very hard to measure maternal mortality empirically because the methods are complicated,” Roberton says. “We are not going to have any actual measurements for a while.”
What he can say is that fewer people overall have been coming to health facilities for care: He has seen unpublished data showing a 10 to 20 percent decline for the period of April through June. Labor and delivery is following this same trend—fewer women have come in to deliver babies, Roberton says.
More deliveries at home means more people giving birth without access to medicines that can halt common problems, such as hemorrhaging after birth. “If they have complications, they are not able to get quickly to a health-care facility,” Roberton says. Even if they do come in, COVID-19 has disrupted supply chains for medicines, so clinics may not have the drugs available to help those in labor. A survey by the World Health Organization showed that 90 percent of countries experienced disruptions to their health-care system, including medications and family-planning services, both of which can affect maternal mortality.
For pregnant people who do contract COVID-19, the complications multiply. To begin with, a positive case can bring stigma. In India, a family abandoned a pregnant woman after she tested positive for the coronavirus. In Guyana, a nurse who contracted COVID-19 while pregnant says that her family was shunned, according to the Pan-American Health Organization (part of the WHO).
Pregnant people are at high risk of developing severe COVID-19, and have a higher rate of preterm birth if they get the virus. They also have been excluded from vaccine safety and efficacy tests, although the American College of Obstetricians and Gynecologists recommends that pregnant and breastfeeding women receive a vaccine as soon as they are able. “Experts believe [the vaccines] are unlikely to pose a risk for people who are pregnant,” the CDC advises. “mRNA vaccines do not contain the live virus that causes COVID-19 and therefore cannot give someone COVID-19.”