Enhancing Maternal and Child Health in Sub-Saharan Africa: The Impact of Economic Growth, Recessions, and COVID-19 Pandemic Mitigation Measures

Abstract

Background: The Sub-Saharan Africa region records the highest number of pregnancy-related deaths and under-five deaths, presenting significant risks for women and children. Globally, ending preventable maternal and child deaths is recognized as a crucial objective and an essential part of global health initiatives. For many low-income countries, macroeconomic growth has been advocated as a policy instrument for enhancing maternal and child health outcomes as the benefits of such economic growth are channelled into investments in medical advancements aimed to enhance the health and wellbeing of the populace. However, the assumption that economic growth always leads to better maternal and child health has faced challenges. Additionally, given the adverse health and economic consequences resulting from the COVID-19 pandemic, it is now more imperative than ever for governments to formulate actionable plans to alleviate the impact and enhance maternal and health outcomes. Objective/Method: This thesis is guided by three overarching objectives. Firstly, it conducts an in-depth examination by systematically reviewing, consolidating, and synthesizing literature at a sub-continental level to understand the impact of economic growth and recessions on maternal and child health outcomes in sub-Saharan Africa, while analyzing crucial socioeconomic factors highlighted in the included studies. Secondly, the research employs subnational data to examine the impacts of the COVID-19 pandemic on the utilization of maternal and child health services in Ghana. Additionally, it explores the impacts of the COVID-19 pandemic and the consequences of the pandemic-induced economic crisis on the nutrition and food security of women and children in Ghana. The study adopts a socio-economic interdisciplinary approach, drawing theoretical grounding from the social ecological theory, a multi-level nutritional framework, and demand and supply framework to analyze the interrelationships among these factors. Methodologically, the study utilizes data triangulation from diverse sources including structured journal searches, analysis of routinely collected secondary health data, and the analysis of 31 semi-structured interviews involving government officials, local NGO leaders, local leaders, frontline workers, female community members, and COVID-19 survivors and partners. Results: The systematic review indicates that although economic growth could potentially enhance maternal and child health through investments, its positive effects are not assured due to various intervening socioeconomic factors at multiple levels, encompassing national, community, household, and individual levels. Additionally, the quantitative research demonstrates that the pandemic led to substantial declines in Maternal and Child Health (MCH) service utilization, however, with variations in severity linked to the rate of infections in a particular region. Intriguingly, further analysis to understand the contribution of the extra restrictions imposed by lockdowns on access and utilization of MCH suggest that the lockdown period did not contribute significant declines, as anticipated, in the rates of first and forth antenatal attendance in the Greater Accra region. The implementation of strategies at the institutional level mitigated the fear of individuals and improved trust in healthcare professionals while ensuring continuous access to routine maternal and child health services. Lastly, the qualitative study underscores that the pandemic exacerbated nutrition and food security challenges among women and children, especially in hotspot areas, due to lockdowns, movement restrictions, prolonged school closures, and disruptions in the food value chain affecting incomes and food prices. The findings also highlight disparities, indicating that women with higher education levels and employment in government or major private sectors fared better economically than those with lower education levels in specific non-essential occupations. Conclusion: Overall, this thesis asserts that for sub-Saharan African countries to leverage the full benefits of economic growth while addressing the adverse effects of recessions and pandemics on maternal and child health, it is significant to consider a range of socio-economic factors, tailored, and purposefully incorporated into health and economic policies and goals. In this present COVID-19 era where even affluent Western nations are facing challenges, it is apparent that sub-Saharan African countries cannot solely rely on achieving high economic growth rates to automatically guarantee a decline in maternal and child health outcomes. It is essential to carefully consider specific multi-level factors within each country and community.