Paying the price for pregnancy

Longer-term impact on survivors

Interdisciplinary research led by the London School of Hygiene & Tropical Medicine has shown that women who survive life-threatening complications relating to pregnancy, abortion or delivery are often affected for a long time afterwards.

Compared with women who have uncomplicated pregnancies and deliveries, women who experience such complications experience a range of negative health, social and economic consequences.

– In addition, even though they initially survive life-threatening complications, these women remain at higher risk of dying even up to four years after the complication, says researcher Katerini T. Storeng.

Katerini has participated in the study from Burkina Faso that examined the impact of near-miss complications on women’s well-being and survival in the longer-term. Such deaths sometimes result directly or indirectly from unresolved health problems relating to the pregnancy complication, exacerbated by health system weaknesses like poor quality of care and financial barriers to care-seeking.

Expensive treatment

User fees and other costs associated with maternity care are high. Emergency obstetric care in particular can lead to catastrophic expenditure. The costs can exceed 10 % of an annual household income.

During her fieldwork in Burkina Faso, Katerini observed that some women continued working in order to appease husbands and co-wives – or simply because it was necessary for survival – despite knowing that hard physical labour would compromise their physical recovery after a complicated delivery. Other women with ongoing illness and disability refrained from asking for treatment for their health problems or had to undergo heavy ordeals in order to collect money for treatment.

The consequences of such ordeals can be as much social as economic. Marie, a young woman who was hospitalised after the delivery of stillborn twins explained how her partner and family scolded her for having brought problems upon them. They eventually abandoned her in the hospital, saying that because she had become so expensive, it was no longer their concern what happened to her.

Strategies for coping with high costs

– Borrowing from relatives, selling agricultural products intended for their own use, or even worse, selling land or household assets, are the strategies used by poor households to cope with health care costs, explains PhD-candidate Patrick Ilboudo.

Given that Burkina Faso is mainly an agricultural-based economy, Patrick asks:

– When you are obliged to sell your land, what will you do afterwards to survive?

The study in Burkina Faso has found that households experience negative impacts on the household economy even four years after women have survived life-threatening complications. One such impact is food security: to feed themselves, they often have to borrow money from relatives or buy food on credit. Sometimes their children are obliged to skip some meals.

Conference on Global Health and Vaccination Research

Katerini and Patrick presented their research on long-term mortality at the GLOBVAC-conference in September. The conference in Oslo was visited by nearly 250 people, with participants from many countries such as Malawi, India, Tanzania, The United States, Ghana and Sudan.

About the researchers

Katerini T. Storeng is a postdoctoral fellow at the University of Oslo and honorary lecturer at the London School of Hygiene and Tropical Medicine. She is currently co-leading, with Johanne Sundby, a study on the social and economic costs of reproductive healthcare in West Africa.

Patrick Ilboudo is currently pursuing a PhD in Health Economics at The Institute of Health and Society, UiO. His PhD is part of the study led by Johanne Sundby and Katerini T. Storeng.

Further reading

• Beyond body counts: A qualitative study of lives and loss in Burkina Faso after ‘near-miss’ obstetric complications in Social Science and Medicine 71 (2010) by Katerini Tagmatarchi Storeng, Susan F. Murray, Mélanie S. Akoum, Fatoumata Ouattara, Véronique Filippi.
• Paying the price: The cost and consequences of emergency obstetric care in Burkina Faso in Social Science and Medicine 66 (2008) by Katerini Tagmatarchi Storeng, Rebecca F. Baggaleya, Rasmane´ Ganabab, Fatoumata Ouattarac, Mélanie S. Akoumb, Véronique Filippia
• Health of women after severe obstetric complications in Burkina Faso: a longitudinal study in The Lancet vol 370 (2007) by Véronique Filippi, Rasmané Ganaba, Rebecca F Baggaley, Tom Marshall, Katerini T Storeng, Issiaka Sombié, Fatoumata Ouattara,Thomas Ouedraogo, Mélanie Akoum, Nicolas Meda

By Anbjørg Kolaas