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Triplet babies delivered by Canadian OB-GYN Dr. Roopan Gill at Abs hospital in southern Yemen.Handout

Even at the end of a tumultuous year in which a pandemic brought the fragility of human health to the fore, life continues.

No one is more intimately aware of this than the obstetricians, nurses and midwives who have delivered newborns and supported mothers under circumstances that, for many countries, continue to be fatally unmanageable.

And while labour and delivery wards in Canada have adapted to the pandemic with precautions, COVID-19 has brought the dire state of maternal health care in many developing countries into sharp focus, infecting mothers, disrupting prenatal and antenatal care and upending food supply chains.

According to a research paper published in the Lancet, maternal mortalities are anticipated to rise this year, particularly in low- and middle-income countries. The study’s most severe estimate puts the anticipated number of additional global maternal deaths due to both the direct and indirect effects of COVID-19 at 113,400 over a period of 12 months. The actual number of maternal mortalities caused by the virus will likely not be known for years.

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Dr. Gill holds one of the babies she delivered at the Abs Hospital in Yemen in the spring of 2020.Handout

Delivering babies at Abs hospital, 25 kilometres from an active frontline in southern Yemen, Dr. Roopan Gill, a Canadian ob-gyn with Doctors Without Borders, witnessed that disparity firsthand.

Even before the pandemic, mothers-to-be in the region were at a severe disadvantage. In one case, midwives called Dr. Gill in to deliver the second baby of a set of twins and treat the mother for complications. That’s when she noticed a third infant, in breech. The mother delivered the child successfully, but with access to an ultrasound and blood pressure monitoring, a cesarean would have been scheduled.

Still, Dr. Gill says, the health of mothers there in the months before COVID-19 hit, compared with the months after, was starkly different. It wasn’t until after March that she experienced her first in a series of several maternal deaths. One patient she’ll never forget was a pregnant mother of five, who came into the hospital with severe respiratory distress. After delivering a stillborn baby the mother’s symptoms worsened, and a test found her positive for COVID-19.

Dr. Gill remembers holding the woman’s hand in the isolation unit, trying to be reassuring as her team sought out a bed in an intensive care unit. Unfortunately, as with many of Yemen’s COVID-19 victims, the patient died before one became available.

Along with war and famine, natural disasters have also compounded the effects of COVID-19 around the world, throwing health systems into even further states of chaos.

After hurricanes Eta and Iota hit Honduras in November, displacing 95,000 people, the Canadian Red Cross set up an emergency health clinic in the village of La Lima.

Jenn Hewitt, a labour and delivery nurse from Calgary has been there since the early days.

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Labour and delivery nurse Jenn Hewitt talks to a patient in early December in the women's tent of an emergency clinic in La Lima, Honduras, run by the Canadian Red Cross.Johannes Chinchilla

She says the hurricanes forced many clinics to close, and she frequently sees women who have not had prenatal medical care, which means they could develop undetected high blood pressure or gestational diabetes. Missed postdelivery visits put mothers and babies at risk of infection.

The loss of their homes due to the hurricanes means some pregnant women have been forced to shelter in crowded, unhygienic conditions, increasing their chances of contracting COVID-19.

In addition, Ms. Hewitt says many of the patients are teen mothers, who are more at risk of complications. Pregnancy is the leading cause of death for girls aged 15-19, globally.

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Ms. Hewitt, caring for patients in Honduras, says in comparing her prenatal patients to those in Canada, she’s come to believe 'having access to good health care is really such a privilege.'Johannes Chinchilla

The Guttmacher Institute, sexual and reproductive health policy and research institute based in New York, has estimated that since health care – and by extension access to contraceptives – has been disrupted, the pandemic will result in 15 million additional unintended pregnancies. Such a surge would stress already overstretched maternal health care systems.

Ms. Hewitt says that in comparing her prenatal patients in Honduras to those in Canada, she’s come to believe “having access to good health care is really such a privilege.”

Dr. Gill concurs. “There were a lot of articles at the beginning of the pandemic about how COVID-19 would be the great equalizer, that it doesn’t differentiate between different socioeconomic groups.”

“To me, I disagree with that.”

Dr. Gill recalls the Yemeni mother of five who passed away after testing positive for the virus: “In a setting like Canada, this woman would have survived, potentially. In Yemen, she didn’t.”

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