A recent study published in The Lancet Global Health reveals that a minimum of 40 million women each year are likely to face enduring health issues resulting from childbirth. As part of a special series on maternal health, the study sheds light on the high burden of postnatal conditions that persist for months or even years after giving birth. These include dyspareunia (35%), low back pain (32%), anal incontinence (19%), urinary incontinence (8%–31%), anxiety (9%–24%), depression (11%–17%), perineal pain (11%), tokophobia (6%–15%), and secondary infertility (11%).
The authors of the paper stress the need for greater recognition of these common problems within the healthcare system, particularly as many of these conditions extend beyond the period where women typically have access to postnatal services. They argue that effective care throughout pregnancy and childbirth is crucial not only for addressing immediate concerns but also for detecting risks and preventing complications that can lead to lasting health issues after birth.
Dr. Pascale Allotey, Director of Sexual and Reproductive Health and Research at WHO, emphasizes the considerable suffering caused by postpartum conditions in women's daily lives, both emotionally and physically. Despite this, these conditions are often underappreciated, underrecognized, and underreported.
The study reveals that, despite their prevalence, postnatal conditions have been largely neglected in clinical research, practice, and policy. In a literature review spanning the last 12 years, the authors found no recent high-quality guidelines for effective treatment for 40% of the 32 priority conditions analyzed. Furthermore, there were no high-quality guidelines from low- or middle-income countries, highlighting significant data gaps.
The Lancet's special series, titled “Maternal health in the perinatal period and beyond,” advocates for a holistic approach to reduce maternal deaths. This approach goes beyond addressing immediate biomedical causes and takes into account the complex interplay of broader social, economic, and environmental conditions affecting women's health. Factors such as racial and gender inequities, economic context, nutrition, sanitation, environmental risks, and exposure to violence and conflict are crucial considerations.
The series contends that the lack of attention to fundamental issues explains why 121 out of 185 countries have failed to significantly progress in reducing maternal deaths over the past two decades. Joao Paulo Souza, Center 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, emphasizes that maternal health should not be a concern only during pregnancy but requires a comprehensive approach addressing various factors influencing women's health throughout their lives.
Fundamentally, the series argues for a strong, multidisciplinary health system that not only provides high-quality and respectful maternity services but also prevents ill health and mitigates the impact of broader inequities. This includes specific interventions to support the most vulnerable women and girls. The goal is to shift the focus from maternal health solely during pregnancy to a more comprehensive approach that considers women's health before, during, and after pregnancy.