Postpartum Health Challenges

According to a new study published today in The Lancet Global Health, at least 40 million women are at risk of developing a long-term health problem as a result of delivery each year. The study, which is part of a special Series on maternal health, reveals a high burden of postnatal disorders that remain months or even years after giving birth. More than a third (35%) of postpartum women experience pain during sexual intercourse (dyspareunia), low back pain (32%), anal incontinence (19%), urinary incontinence (8-31%), anxiety (9-24%), depression (11-17%), perineal pain (11%), fear of childbirth (tokophobia) (6-15%), and secondary infertility (11%).

The authors of the research advocate for better identification of these prevalent difficulties within the healthcare system, many of which occur after women generally have access to postnatal therapies. They claim that effective treatment throughout pregnancy and labor is also a significant preventive element in detecting hazards and avoiding problems that can lead to long-term health difficulties after birth.

“Many postpartum conditions cause considerable suffering in women’s daily life long after birth, both emotionally and physically, and yet they are largely underappreciated, underrecognized, and underreported,” said Dr Pascale Allotey, Director of Sexual and Reproductive Health and Research at WHO. “Throughout their lives, and beyond motherhood, women need access to a range of services from health-care providers who listen to their concerns and meet their needs – so they not only survive childbirth but can enjoy good health and quality of life.”

Despite their frequency, the report observes that these disorders have been largely ignored in clinical research, practice, and policy. During a 12-year examination of the literature, the authors discovered no recent high-quality guidelines to support successful treatment for 40% of the 32 priority illnesses studied, and not a single high-quality guideline from a low- or middle-income country. There are also severe data gaps: for any of the disorders highlighted in the research, there were no nationally representative or global investigations.

According to its opening paper, reducing maternal deaths requires a holistic approach that focuses not only on their immediate biomedical causes but also on the complex interplay of broader social, economic, and environmental conditions that affect women’s health, such as racial and gender inequities, economic context, nutrition, sanitation, environmental risks, or exposure to violence and conflict. According to the research, a lack of attention to such fundamental concerns explains why 121 out of 185 nations have failed to make meaningful progress in lowering maternal fatalities during the last two decades.

“Maternal health is not just something that we should start worrying about when the pregnancy bump appears,” said Joao Paulo Souza, Centre Director of the Latin American and Caribbean Center on Health Sciences Information (BIREME) for PAHO/WHO and one of the authors of the first paper. “There are many factors that influence the likelihood a woman will have a healthy pregnancy, from the environment around her to the political and economic systems she lives in, to access to nutritious food and the level of agency she has over her life – all of these factors need to be addressed to improve her health, alongside access to high quality healthcare throughout life.”

Fundamentally, the Series advocates for a strong, multidisciplinary health system that not only provides high-quality, respectful maternity care, but also prevents illness and mitigates the impact of broader inequities, including targeted interventions for the most vulnerable women and girls.

Source: World Health Organisation (WHO)

For more information: Neglected medium-term and long-term consequences of labour and childbirth: a systematic analysis of the burden, recommended practices, and a way forward, Lancet Global Health, DOI:https://doi.org/10.1016/S2214-109X(23)00454-0