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 sweeping analysis of maternal health worldwide shows a very high burden of long-term conditions that last for months and even years after giving birth. One in three new mothers worldwide are affected.
The findings emerged from a series published in the Lancet Global Health and eClinicalMedicine, backed by the UN’s Special Programme 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 considerable suffering in women’s daily life long after birth, both emotionally and physically, and yet they are largely underappreciated, underrecognised, 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 they not only survive childbirth but can enjoy good health and quality of life.”
The analysis examined health problems arising or continuing six weeks after childbirth or later. These included pain during sex, affecting 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 called for greater recognition within the healthcare system of these common problems, many of which occur beyond the point where women typically have access to postnatal services.
Effective care throughout pregnancy and childbirth was also a critical preventive factor, in order to detect risks and avert 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 cautioned. There were no nationally representative or global studies for any of the conditions identified through the research.
Available data was largely limited to wealthier nations, and the 40 million figure might underestimate the true global burden, the researchers said. About 140 million women give birth every year.
The wider series 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 significantly progress in reducing maternal deaths over the past two decades, the study says.
“Maternal health is not just something that we should start worrying about when the pregnancy bump appears,” said João Paulo Souza, the centre director of the Latin American and Caribbean Center on Health Sciences Information 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, or access to nutritious food and the level of agency she has over her life – all of these need to be addressed to improve her health, alongside access to high-quality healthcare throughout life.”