Maternal deaths in Ituri province, the epicentre of the Democratic Republic of Congo’s deadliest Ebola epidemic, are surging as the fastest-growing outbreak in history outpaces the health response. In just over three months since the outbreak was declared, deaths among pregnant women have roughly doubled, the United Nations reproductive health agency, or UNFPA, told The Independent, with 63,700 pregnant women still at risk in affected areas. Overall, more than 2,600 people have died during the outbreak – with more than 5,500 cases found.
Ebola restrictions placed on frontline health facilities are preventing some blood transfusions being administered, potentially contributing to increasing maternal mortality, a separate aid source told The Independent. In July, a refusal to administer a blood transfusion to a woman with severe anaemia, who then died, led an angry mod to storm the Ituri hospital that had been treating her. As a result, several of their 10 Ebola patients escaped, potentially spreading the virus to others.
Even before this Ebola outbreak, the DRC already had one of the highest rates of maternal mortality globally, with ongoing conflict, mass displacement, weak health infrastructure and financial barriers severely limiting access to safe obstetric care. In Ituri province, the epicentre of the outbreak, the health system was already severely strained. Maternal haemorrhage, including severe bleeding after childbirth, is the leading cause of maternal death worldwide, with anaemia increasing the risk of severe complications and death.
A fifth of pregnant women in the DRC suffer from the deficiency, rising to 40 per cent in some parts of the country. Previous Ebola outbreaks have shown alarming maternal mortality rates – catching the virus during pregnancy has historically killed between three-quarters and all women, with an almost 100 per cent rate of fetal loss, miscarriage or stillbirth. Epidemics also overwhelm clinics and strain health systems, preventing women from accessing routine care and safe deliveries.
Women now account for more than half of confirmed Ebola cases – originating in a mining area, the outbreak originally affected more men, but women’s roles as primary caregivers for the sick and as health workers has shifted the balance. At least 160 frontline health workers have been infected and 43 have died, with more than ten cases a week in high-transmission zones. Midwives face a very high risk of infection due to exposure to bodily fluids during childbirth, and require personal protective equipment and targeted training.
Nurses represent more than a quarter of health worker cases. Nearly seven in ten of new health workers globally are women, as well as more than 80 per cent of nurses and 96 per cent of midwives, according to a study published in The Lancet Public Health last week. Less than half of doctors are women.
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