Pregnancy during a Pandemic: Covid-19’s Pronounced Effect on Women’s Health in Southeast Asia

Over the past year, the Covid-19 pandemic has claimed over half a million lives in the United States alone. While resources such as personal protective equipment and vaccines are a step in the right direction, women’s health has severely declined as a whole, particularly in developing nations. Southeast Asian countries, especially those where the culture dictates certain topics as taboo, have left women vulnerable to increased mental illnesses as well as surging newborn mortality.

Prenatal Depression

While postpartum depression is commonly recognized, prenatal depression is also prevalent among women, especially during the Covid-19 pandemic. In a survey of 552 pregnant women in Lahore, Pakistan, 39% of these women had developed depression. The Edinburgh Postnatal Depression Scale revealed that approximately 6% of respondents suffered from maximum depression. Although this figure could be attributed to biological factors during pregnancy, the majority of women report psychological factors as the cause, including feelings of vulnerability to the virus and the fear of transmission or harm to the fetus.

Despite knowledge about mental illnesses, there is stigma surrounding such topics in Pakistan. While there is increased support in high-income countries like the United States to pregnant women, this sentiment generally does not translate to the realities of low and middle-income countries, making it increasingly difficult for expectant mothers to adequately address mental health concerns. In order to mitigate the issue, educational initiatives and proper support systems should be implemented to ensure mental well-being.

Labor and Hospitalization

In addition to increased anxiety and depression among pregnant women, birth complications have increased significantly. In high-income countries like Canada, the preterm birth rate is about 8%, compared to 16% in Pakistan, thus making the latter the country with the world’s highest rate of preterm birth. Pakistani women are exposed to a plethora of stressors which increase the risk of preterm birth. Because stressors and their effects are location-dependent, it is evident that the tension caused by Covid-19 has taken a larger toll on Pakistani women. This trend correlates not only with the stigma surrounding mental health, but also with the fact that Covid-19 is handled less effectively in Southeast Asia, due to lack of mask and social distancing mandates as well as decreased vaccine availability.

With new Covid-19 protocols, hospitalization procedures have also changed drastically. The number of women who go to the emergency room for labour has declined significantly due to changes in public transport and emergency room logistics. There was a 49.8% decrease in women hospitalized for labor as compared to the same calendar period from the previous year. Not only do at-home births jeopardize the life of the newborn, but this alternative also exposes the mother to countless additional risks. These risks serve as additional stressors, thus reinforcing dangerous preterm birth and potentially resulting in devastating newborn deaths.

Looking Ahead

While Covid-19 has accentuated shortcomings and failures in healthcare systems, the health crisis  has also shed light on women’s health, especially in regions where such conversations are silenced due to cultural norms. The mental challenges that pregnant women face have perilous consequences to their own lives as well as those of newborns. To mitigate these effects, governments must foster educational initiatives starting from a young age for women. Partnerships with mental health and womens’ health organizations can facilitate the distribution and instruction of such lessons which will gradually eradicate the shame or reservation that surround these topics. Only then will women be able to seek the proper care needed, thus resulting in safer and happier pregnancies — even during a pandemic.

Sources

1. Shahid, Ayesha, et al. Evaluation of Psychological Impact, Depression, and Anxiety among Pregnant Women during the COVID‐19 Pandemic in Lahore, Pakistan. 17 Oct. 2020, obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.13398.
2. Premji, Shahirose Sadrudin, et al. “COVID-19 and Women's Health: A Low- and Middle-Income Country Perspective.” Frontiers, Frontiers, 17 Sept. 2020, www.frontiersin.org/articles/10.3389/fgwh.2020.572158/full.
3. Mehta, Kalpana, and Rahul Choudhary. “COVID-19 Outbreak and Decreased Hospitalisation of Pregnant Women in Labour.” The Lancet Global Health, 14 July 2020, www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30319-3/fulltext.