Monday, November 23, 2020

In Gaza, maternal deaths on the rise amid lack of family planning

By Yehudit Tzfat - November 05, 2019
Section: [Main News] [Features]
Tags: [women‘s rights]

The mortality rate of pregnant women in Gaza has declined over the last 25 years. But new data from the Ministry of Health points to a worrying trend showing maternal deaths are on the rise. 

With two months left in 2019, 14 pregnant women have died so far in Gaza, according to the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA). In 2018, 11 maternal mortality cases were documented. 

“Increasingly we are seeing these deaths happening during pregnancy as opposed to after birth and what that tells us is that a lot of the problem probably lies in the primary healthcare system,” Kristine Blokhus, the Palestine Representative for United Nations Population Fund (UNFPA), said. 

A new report released by The United Nations Office for the Coordination of Humanitarian Affairs in the Occupied Palestinian Territory, in collaboration with the UNFPA, suggested that a lack of family planning supplies and essential medicines is putting Gazan mothers at risk of death. According to the report, “two out of the five essential family planning supplies (progesterone-only pills and male condoms), have been at zero stock at [Ministry of Health] and UNRWA clinics in Gaza for much of 2019.” 

Additionally, the percentage of essential drugs at zero stock level is rising steadily in Gaza. In 2017, essential medications with less than a month’s supply averaged at 38 per cent. This percentage rose to 46 in 2018. And now it stands at 50 per cent as of August, with an average of 42 per cent of essential medicines at zero stock in 2019. Maternal and child pharmaceutical drugs are frequently the most impacted. 

Iron and folic acid are affected by ongoing shortages. These supplements are used to treat and prevent anaemia caused by micronutrient deficiencies in pregnancy. Having anaemia while pregnant increases the risk of health complications for women such as haemorrhage and ability to tolerate blood loss, which can lead to circulatory shock and even death. The low supplies of iron and folic acid have contributed to a spike in anaemia cases, with 2018 seeing 40 per cent of pregnant women diagnosed with the condition.   

Dr Randa Zaqout, who works at a UNRWA clinic in Gaza, said the shortage of family planning supplies, such as contraception and condoms, at the Ministry of Health, is contributing to this rise in maternal deaths. “Sometimes the only way to prevent maternal mortality is to prevent pregnancy,” Zaquot said. 

Multiple sources familiar with the issue indicated that a lack of funding is a possible root cause of this growing problem with women’s health. UNFPA’s Blokhus explained that the “vulnerable and fragile system” of healthcare in Palestine makes it difficult to maintain. Gaza’s health sector specifically is made up of public care provided by the Ministry of Health, NGOs and the private establishment. 

“The system here is very dependent on donors so the fluctuation in budgets can happen very quickly,”  Blokhus said, noting how the recent decrease in UNRWA funding has impacted Gaza’s healthcare significantly. 

Healthcare professionals in Gaza have repeatedly noted a reduction in funding for the Ministry of Health. Dr Nahla Heles in Gaza said the government continuously tells her they don’t have sufficient funds to offer vital medications and family planning supplies. 

“They don’t have enough money to support the essential drugs,” she said. “They don’t have enough money to run the Ministry of Health.”

According to the 2018 Gaza Financial Report from the Ministry of Health, a sharp reduction occurred in funding for medications, supplies, and health workers’ salaries. In 2016, nearly NIS 300 million [about $85 million] or 46.9 per cent went to salaries and wages. For 2018, salaries and wages made up 24.5 per cent of the allocated funding at about NIS 110 million [roughly $31 million]. In 2017, almost NIS 100 million [around $28 million] went to medicines, but that amount dropped by roughly 25 per cent in 2018. And between 2016 and 2018 the funding for medical supplies nearly halved. The Ministry of Health did not respond to repeated requests for comment. 

The Palestinian Authority is responsible for the medicine supply in Gaza. Yet the government’s current financial crisis coupled with tensions between the two governmental forces in Palestine — the PA and Hamas — is partially responsible for the drug shortage. 

Dr Zaquot noted, however, that salary cuts affecting staff motivation and the limited availability of essential medications are not the only potential contributors to a decline in women’s health in Gaza. 

“You don’t have only one cause contributing to the increase of maternal mortality,” Zaquot said. “The health condition of the people is deteriorating year after year, with more than 10 years of [the] Israeli blockade.”

Blokhus agrees Israel’s blockade of Gaza has impacted the health sector in the region, with restrictions on medical equipment and movement of medical staff.

“The blockade may have entrenched some of the administrative divides. The Ministry of Health is working across a physical divide of location so all of these things play in,” Blokhus said. 

But the financial problems go beyond the Ministry of Health funding issues. Dr Zaquot mentioned how the rising unemployment rates in Gaza, especially among women, makes access to health services increasingly difficult. 

“Sometimes the patients don’t come to the health centres and when we ask them why they say they didn’t have the money to come,” Zaquot said. “They don’t have the transportation costs to come to the health centres.”

The unemployment rate in Gaza stands at 52 per cent as of 2018, according to the Palestinian Central Bureau of Statistics. Women’s unemployment is significantly higher at 74.5 per cent. Only a quarter of Gazan women participate in the workforce. 

“Women in Gaza or Palestine are more vulnerable because still not all women are empowered,” Zaquot said. She explained that the disproportionate rate of women’s unemployment affects their access to health services. But in addition to the weakened economy, Dr Zaquot suggested that the high rate of gender violence in the Gaza Strip might also have an impact on women’s health. 

“The blockade and socioeconomic conditions affect gender-based violence and make women more vulnerable to health issues.”


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