In the past few years, however, some countries had had some small successes: In 2013, Liberia reported a modest reduction in both maternal and infant mortality rates, for example.
Ebola may prove a major setback. The latest outbreak is causing a major disruption to the health-care system, and there are numerous signs that pregnant women in Liberia, Sierra Leone and Guinea could be dying due to Ebola without ever getting the disease.
For a glimpse of the problem, read this anecdote from The Post's report on how regular medical treatment is being disrupted by Ebola:
As a Washington Post photographer watched one day last week, a woman in labor arrived at the JFK Ebola treatment center in a taxi, sent by workers at the hospital’s recently reopened maternity ward because she had no evidence that she was free of Ebola.But no one came to the Ebola facility’s gate — and even if someone had, the woman’s chances of gaining entry were next to zero. With no evidence that she had Ebola, the isolation center would not bring her inside among those who have the virus.
The story highlights one significant aspect of the problem: Maternity hospitals are fearful of taking women in due to the risk of catching Ebola from a sick patient. That fear is understandable. Hundreds of health-care workers have been infected with Ebola recently, and many were infected by the patients they treat.
Bruce Aylward, assistant director-general for polio and emergencies at the World Health Organization, said that at first, most health workers who died were people working in "poorly run Ebola treatment centers." However, as the disease spread, it began to affect the broader health community. "Now, if you look at [health-care workers infected with Ebola], they're somebody who is delivering a baby in a clinic that had nothing to do with Ebola," Aylward explained. The shift has affected both local and foreign doctors: Rick Sacra, one of the American doctors who contracted Ebola, was treating pregnant women in Liberia when he became infected (he has since made a full recovery).
Worse still, the fear of Ebola infection at medical facilities cuts both ways. Many pregnant women who need treatment are too scared to head to a health center, fearing a visit to a medical facility will actually increase their chance of catching Ebola. In countries where maternal mortality rates are so high than almost one out of every hundred women die, such a lack of treatment can have a deadly impact.
Exactly how big of an impact Ebola is having on women and infants is hard to ascertain in the middle of the crisis. "I don't think there is any data yet," Carolyn Miles, president and CEO of Save the Children, said Sunday. "But it's not going to be good data when we get it."
What little information there is should cause concern: WHO cites information from the Liberian government that appeared to show the number of women receiving prenatal care within six weeks of confirming their pregnancies was just 25 percent from May to August, down from 49 percent for the same period the year before.
"I have information that in Sierra Leone, that we've had to cut back on almost 50 percent of the consultations for pregnant women," said Babatunde Osotimehin, executive director of UNFPA, the United Nations Population Fund. "That has implications for their ability to do even routine things, but more importantly when a Cesarean is needed [and] when they need active care.
"That's all gone," Osotimehin said. "I worry about that."
There are other issues that compound the problem further. Many women are already the primary caregiver in their communities, meaning that Ebola cases disproportionately affect women. There are also serious issues with getting food and other supplies in certain areas, and aid agencies are struggling to keep up. "We can't have 10,000 people lining up somewhere to get food," said Bettina Leuscher, chief spokesperson for global issues at the World Food Programme.
There isn't an easy solution. "Information is going to be key," Osotimehin said, adding that governments need to work to educate people about what are risks and what are not.
"You've got to keep your health facilities open, you've got to keep them working, and you've got to keep them safe," Aylward explained.
For health systems that have never been in good shape, that is a difficult task – and the problems for maternal health care are only one symptom of an even wider health-care problem."There was a fragility in the system, even before Ebola," Osotimehin said. "Now Ebola has come, it has overwhelmed the system."