More than 40 million women a year experience lasting health issues after childbirth, a global review has found, prompting calls for greater recognition of common postnatal problems.
The comprehensive analysis of maternal health worldwide shows a very high burden of long-term conditions that last months and even years after birth. One in three new mothers worldwide is affected.
The findings come from a series published in the Lancet Global Health and eClinicalMedicine, backed by the UN Special Program on Human Reproduction, the World Health Organization and the US Agency for International Development.
Prof Pascale Allotey, the director of sexual and reproductive health and research at the WHO, said: “Many postpartum conditions cause significant suffering in women’s daily lives long after birth, both emotionally and physically, and yet they are largely underappreciated, underrecognized and underreported.
“Throughout their lives, and beyond motherhood, women need access to a range of services from healthcare providers who listen to their concerns and meet their needs – so that they can not only survive childbirth, but enjoy good health and quality of life.”
The analysis looked at health problems that started or persisted six weeks after delivery or later. These included pain during sex, which affects more than a third (35%) of postpartum women, low back pain (32%), anal incontinence (19%), urinary incontinence (8-31%), anxiety (9-24 %), depression (11-17%), perineal pain (11%), fear of childbirth (6-15%) and secondary infertility (11%).
Researchers have called for greater recognition within the healthcare system of these common problems, many of which occur beyond the point where women typically access postnatal services.
Effective care through pregnancy and delivery was also a critical preventive factor in detecting risks and preventing complications that could lead to lasting health issues after birth, they added.
Despite their prevalence, such conditions have been largely neglected in clinical research, practice and policy, experts say.
In a review of documents spanning more than a decade, the researchers identified no recent high-quality guidelines to support effective treatment for 40% of 32 priority conditions. They did not find a single high-quality guideline from a low- or middle-income country.
Data gaps were also significant, the researchers warned. There were no nationally representative or global studies for any of the conditions identified by the research.
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Available data was largely limited to wealthier countries, and the figure of 40 million may underestimate the true global burden, the researchers said. About 140 million women give birth each year.
The wider range on maternal health in the perinatal period and beyond calls for greater attention to the long-term health of women and girls – both before and after pregnancy.
Lack of attention to such fundamental issues helps explain why 121 out of 185 countries have failed to make significant progress in reducing maternal mortality over the past two decades, the study says.
“Maternal health is not only something we should start worrying about when the pregnancy bump appears,” says João Paulo Souza, the center director of the Latin American and Caribbean Center for Health Sciences Information and one of the authors of the first article.
“There are many factors that affect a woman’s likelihood of having a healthy pregnancy, from the environment around her to the political and economic systems she lives in, or access to nutritious food and the level of agency she has over her life has – all of which must be addressed to improve her health, along with access to high-quality health care throughout life.”
