A heavily pregnant 19-year-old with high blood pressure lost her baby and went partially blind after she was turned away from a Port Moresby hospital in April, as the hospital had no temperature-testing facilities to confirm she was not carrying COVID-19.
One of the country’s obstetrics experts then advised women in Papua New Guinea not to fall pregnant in the next two years. But according to the latest projections from The United Nations Population Fund, a lockdown of just six months will result in 7 million unintended pregnancies.
Experts worry about the ongoing impact of the pandemic in a country with a high maternal mortality rate and scarce access to family planning services.
“There will be an increase in teenage pregnancies which can lead to an increase in maternal deaths and neonatal deaths,” said Plan International PNG’s health program coordinator Anne*. “Abortion is illegal in PNG as a whole.”
Anne, who has been working in sexual health since 2006 when she volunteered at a clinic, says Plan International has paused sexual health training sessions because of social distancing requirements in the autonomous region of Bougainville.
“It has caused an abrupt stop to our working relationship and the activities we provide in our communities,” she said.
Plan International Australia chief executive Susanne Legena says the Pacific has some of the highest “unmet family planning needs” in the world and very low contraceptive prevalence. She says her organisation’s workers in the region had already reported “really high rates of unplanned pregnancies” since the pandemic began.
“Complications related to pregnancy are the number one killer of girls aged 15 to 19 worldwide and so that [lack of education] is going to be really significant,” she said.
Legena says they are preparing for a “shadow” pandemic in which there is an aftermath of reproductive healthcare challenges beyond the initial disruption.
Plan International research conducted during the Ebola crisis in Western Africa from 2014 to 2016 showed a 75% increase in maternal mortality during that crisis alone due to a sharp rise in the number of unassisted births, teenage pregnancies and unsafe abortions. In some communities in Sierra Leone, teenage pregnancy rates increased by up to 65%.
“This is a hidden problem until you have complications in childbirth and all the other things we saw in Sierra Leone for Ebola,” she says. “The way that pandemic played out was that people couldn’t access the services they needed and it resulted in more complications in childbirth and the death of women and there is clear evidence from COVID-19 that it is on track to do the same.”
Some organisations are no longer travelling to rural and remote areas, while other service delivery points are reducing operating hours or closing altogether. Most group training on sexual health and reproductive rights have been cancelled as the result of physical distancing measures.
When PNG’s lockdown first came into effect in March, not-for-profit family planning organisation Marie Stopes briefly suspended its services, says the group’s PNG director David Ayres.
“We had to make sure we were protecting our staff and our clients,” Ayres said. “We’ve had a staged reopening where we deliver services through different channels.”
But the riskiest challenge is planning how outreach teams, which often do homestays in remote communities, will travel around to provide contraception, Ayres says.
“We can [usually] reach people that nobody else can reach as [the workers] will often drive or even walk for a couple of days to reach women,” he said. “We are the only option they have in terms of family planning services.”
Ayres is concerned the long-term impact of the pandemic will be an increase in unsafe abortions and unsafe pregnancies and births.
“Even for services that are operational there has been a sharp reduction in service delivery because of people’s fears about accessing health services during the pandemic and that will take some time to get back,” he said.
In 2017, for every 100,000 live births in PNG, 215 women died in complications resulting from labour. In Australia the same year that number was less than seven per 100,000 live births. In PNG in April, the pandemic’s disruption to public transport cost one woman her life.
“There was a young mother in [PNG’s Western Province] who was giving birth and there were complications with the birth and normally she would be able to get public transport to get to the hospital,” Ayres said.
“That young woman died giving birth and that could have been avoided.”
*Last name withheld.