ANCHORAGE, Alaska — Motherhood can be arduous for even the most privileged, but for the estimated 388 million women and girls living in extreme poverty, the risk of depression, poor maternal and infant health and rates of mortality are discriminatingly high. Recent studies demonstrate that poverty not only compounds and contributes to the deterioration of the mental and physical health of childbearing women, but that poverty and maternal health have a profound impact on children.
Poverty Disrupts the Maternal Brain Functioning
Poverty impacts nearly every facet of women’s health but has particularly devastating effects during and after pregnancy. As a 2017 study noted, postpartum depression is one of the least treated but most prevalent health conditions of mothers in developing countries.
A 2014 study of maternal depression in developing countries concluded that women who live in low-income settings are two to three times more likely to suffer from mental health issues than women in high-income countries.
A separate 2014 study assessing the effects of poverty on maternal brain functioning identified neurobiological risk factors among pregnant women in poverty. The study concluded that chronic stress as a result of poverty interrupts the natural adaptive processes and normative biological changes of a mother’s brain, which regulate maternal sensitivity and prepare the brain for parenthood. Furthermore, neuroimaging through fMRI scanning concluded that people who experience high levels of poverty-associated chronic stress can experience injury to the emotional regulation system of the brain.
For mothers, the study suggests that this injury results in the disruption of critical maternal biological changes, leading to a higher risk of anxiety and depression, harsh parenting, lack of motivation, a dysregulation of emotion and an overall reduction in neurobiological responses from mother to child.
Existing Factors Compound Poverty’s Stronghold
Women in developing countries are most at risk as recent projections from the U.N. estimate that 62.8% of women and girls currently living in extreme poverty reside in sub-Saharan Africa and 20.9% in Central and Southern Asia.
A 2017 study on maternal health in India found that the risk factors for postpartum depression include “financial difficulties, presence of domestic violence, past history of psychiatric illness in mother, marital conflict, lack of support from husband and birth of a female baby,” considering India’s societal preference for male babies.
Women refugees make up more than 50% of all refugees worldwide and it is estimated that pregnant refugee women have higher maternal health risks. Studies suggest that even after resettling in high-income countries, refugee mothers are two to five times more likely to develop postpartum depression.
Maternal psychological distress affects not only the mother but her children as well. Long-term studies point to “adverse psychological outcomes” in children, even 10 years after the mental health struggles of the mother.
Children who are born to mothers with mental health disorders in low-income settings are 40% more likely to endure stunting as depression symptoms in mothers are known to lead to functional impairment. Mothers often struggle with basic caretaking tasks, which can directly impact the feeding practices and nurturing care from mother to child.
Analytics continue to suggest a connection between poverty and maternal health in developing countries with a higher risk of preterm birth and low birth weight as well as infant malnutrition and poor infant health. Mothers in low-income settings often have lower breastfeeding success and are less likely to seek immunizations for their children.
Poverty and Maternal Mortality
In addition to having the highest rates of poverty for women and girls, sub-Saharan Africa and South Asia have the lowest rates of maternal health care, and consequently, the highest rates of maternal mortality. In 2019, sub-Saharan Africa and South Asia accounted for an overwhelming majority of 86% of maternal deaths worldwide.
With proper care, almost all maternal deaths are preventable. However, UNICEF estimates the “lifetime risk of maternal death” in low-income countries to be one in 45 whereas the risk for high-income countries is one in 5,400. In sub-Saharan Africa, the rate is even higher at one in 38, with the average age of risk standing at 15 years old.
In sub-Saharan Africa and Southern Asia, according to data from 2015, 50% of women go through childbirth without adequate care. As of 2020, in Africa, there are 3,324 people per doctor and 985 people for every nurse or midwife.
Each year, 1 million children end up motherless worldwide. Two developing nations, Nigeria and India, account for about 33% of the world’s maternal deaths. Lack of professional health care, resource and financial constraints and inability to travel for care contribute to these statistics.
Goals for the Future
The significance of poverty and maternal health are as intertwined as mother and child. A study published in 2022 looked at the effects of the COVID-19 pandemic on health services across 10 nations, ranging from low-income to high-income. About 50% of the countries saw a 5% to 33% decline in maternal services at the onset of the pandemic.
However, maternal mortality rates are seeing improvements. In sub-Saharan Africa, the World Bank estimates that prior to the pandemic, maternal deaths dropped from 241,000 in 2000 to 200,000 in 2017.
The World Health Organization (WHO) is providing support to countries to work toward Sustainable Development Goal 3, decreasing “the global maternal mortality ratio to less than 70 per 100 000 births, with no country having a maternal mortality rate of more than twice the global average” by 2030. The Ending Preventable Maternal Mortality Strategy (6) includes establishing universal health care for maternal and infant health and collecting data across health systems to understand and prioritize the needs of girls and women. Resolving inequalities in access to maternal and newborn health care also forms part of this strategy.
With continued commitments from the international community, both poverty and maternal health can see significant improvements.
– Michelle Collingridge