2023-12-06 22:46:25
Every year, at least 40 million women are likely to suffer from a long-term health problem caused by childbirth, according to a new study (in anlgias) published today in The Lancet Global Health. As part of a series of articles devoted to maternal health, the study shows that postnatal conditions that persist in the months or even years following childbirth represent a high burden of morbidity. These include pain during sexual intercourse (dyspareunia), which affects more than a third (35%) of women in the postpartum period, low back pain (32%), anal incontinence (19% ), urinary incontinence (8 to 31%), anxiety (9 to 24%), depression (11 to 17%), perineal pain (11%), fear of childbirth (tocophobia) ( 6 to 15%) and secondary infertility (11%).
The article’s authors call for greater recognition within the health system of these common problems, many of which occur following women typically access postnatal services. Effective care throughout pregnancy and childbirth is also a key prevention factor, they say, to detect risks and avoid complications that can lead to lasting health problems following childbirth.
“Many postpartum conditions cause considerable suffering in women’s daily lives long following childbirth, both emotionally and physically, and yet they are largely underestimated, insufficiently recognized and reported,” said Dr. Pascale Allotey, Director of the Department of Sexual and Reproductive Health and Research at WHO. “Throughout their lives, and beyond motherhood, women must have access to a range of services from health care providers who listen to their concerns and meet their needs — so that They can not only survive childbirth, but also enjoy good health and a good quality of life. »
Despite their prevalence, these conditions have been largely neglected in clinical research, practice and policy, the paper notes. In a review of the literature spanning the past 12 years, for 40% of the 32 priority conditions analyzed in their study, the authors identified no recent high-quality guidelines likely to support effective treatment and did not found no quality guidelines from a low- or middle-income country. Data gaps are also significant: for none of the conditions identified in the research are there nationally or globally representative studies.
As a whole, the series, entitled “ Maternal health in the perinatal period and beyond » (Maternal Health in the Perinatal Period and Beyond), calls for greater attention to the long-term health of women and girls — following, but also before, pregnancy.
According to the first article (in English) series, a holistic approach is needed to reduce maternal deaths, focusing not only on their immediate biomedical causes, but also on the complex interactions between, more broadly, social, economic and environmental conditions that impact women’s health, including racial and gender inequalities as well as economic context, nutrition, sanitation, environmental risks, or exposure to violence and conflict. The lack of attention to these fundamental issues partly explains why 121 out of 185 countries have failed to make significant progress in reducing maternal mortality over the past two decades, the paper says.
“Maternal health is not something we should only start worrying regarding when the expectant mother’s belly becomes rounder,” said Joao Paulo Souza, director of the Health Sciences Information Center for Latin America and the Caribbean (BIREME) for PAHO/WHO and one of the authors of the first article. “Many factors influence a woman’s likelihood of a healthy pregnancy, from the environment around her, to the political and economic systems in which she lives, to access to nutritious food and the level of autonomy she has in her life — all of these factors need to be considered to improve her health, alongside access to quality health care throughout life. »
Basically, the series of articles advocates for a strong and multidisciplinary health system, which not only provides quality and person-friendly maternity services, but also prevents health problems and mitigates the impact of broader inequalities — through specific interventions that support the most vulnerable women and girls.
Contacts
Laura Keenan, [email protected]+41 79 500 65 64 et [email protected]
Note to editors
The series can be viewed here: www.thelancet.com/series/maternal-perinatal-health
About the series
The series of articles is published in The Lancet Global Health et eClinicalMedicine. It was supported by the Special Program for Research, Development and Research Training in Human Reproduction (HRP), WHO and the United States Agency for International Development. It consists of four articles:
A global analysis of the determinants of maternal health and transitions in maternal mortality (A global analysis of the determinants of maternal health and changes in maternal mortality) Vulnerabilities and reparative strategies during pregnancy, childbirth, and the postpartum period: moving from rhetoric to action (Vulnerabilities and restorative strategies during pregnancy, childbirth and the postpartum period: moving from rhetoric to action)Neglected medium-term and long-term consequences of labour and childbirth: a systematic analysis of the burden, recommended practices, and a way forward (Neglected medium- and long-term consequences of labor and childbirth: a systematic analysis of the burden of disease, recommended practices and a way forward)Towards a better tomorrow: Addressing intersectional gender power relations to eradicate inequities in maternal health (Towards a better future: tackling cross-cutting gender power relations to eradicate inequalities in maternal health)
About the data
In the third article, long-term postnatal conditions are defined as those that occur more than six weeks following delivery, which is when postnatal care usually stops. The study focuses on conditions that are directly or primarily related to the consequences of labor and delivery. Causes may be related to medical interventions during labor and delivery, such as cesarean section or episiotomy, but the conditions can occur regardless of how a woman gives birth, and without other complications.
In the absence of nationally representative surveys, data on the prevalence of identified conditions are mainly derived from representative household surveys or large maternity registers; 46 are systematic reviews. Available data are largely limited to high-income countries, and total figures may underestimate the true burden of these conditions.
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