As the rate of coronavirus infections and COVID-19 deaths continue to increasein Brazil , where two variants have been identified, the Health Ministry has made an unusual appeal.

"If it is possible, it would be better to postpone pregnancies until a moment when the situation is a little more relaxed," Raphael Camara Parente, Brazil's secretary of primary health care, said in a public statement released earlier in April. "We cannot say this to those who are 42, 43 years old, of course, but, for a young woman who can, the best thing is to wait for a little," he said.

Brazil currently has a seven-day average of 58,303 daily infections and 2,545 deaths. The pandemic has already led to a collapse of public health services in several regions. This means that they pregnant people cannot count on reliable medical care in the event of complications before, during or after childbirth, or if they contract COVID-19.

The number of pregnant people who have died of COVID-19 has increased sharply. An average of 22.2 pregnant people died of COVID-19 each week in the first quarter of 2021. That is nearly double the weekly average of 10.4 for 2020 as a whole.

'The biggest problem'

A lack of access to intensive care was responsible for 22.6% of deaths of pregnant people. About one-third of women were not put on ventilators even when they were in the intensive care unit.

"Respiratory distress is the biggest problem linked to COVID-19. That is why infected pregnant women must have the option of being artificially ventilated," the obstetrician Rossana Pulcineli Vieira Francisco told the Folha de S. Paulo newspaper. "If they die before that, it means they didn't get the medical care they needed.”

Francisco teaches at the University of Sao Paulo. In addition to the lack of intensive medical care in Brazil, she said, many people have to travel long distances to even reach a doctor.

High C-section rate

In Brazil, according to official figures, maternal mortality is about 60 deaths per 100,000 live births. In Argentina, the figure is 39, according to the World Heath Organization (WHO), and 19 in the US. Maternal mortality in Brazil appears likely to skyrocket as a result of the pandemic.

The figures are all the more serious in view of the fact that 55.5% of children in Brazil are born by cesarean section, which means that most births take place in hospitals. Brazil has the world's second-highest C-section rate, after the Dominican Republic's 58.1%. By comparison, the C-section rate in Germany is 29% (2019), according to the Federal Statistics Office, and 32% in the United States, according to the World Health Organization .

Francisco said the maternal mortality in Brazil had been difficult to address before the pandemic. Birth preparedness, screening and postpartum care were patchy in public health care, she said.

"The corona pandemic exposed these deficiencies even more starkly, and also revealed the extreme divergences in health care across Brazil's 27 states," Francisco said.  

The Brazilian demographer Jose Eustaquio Diniz Alves wrote recently that the pandemic had reinforced a falling birth rate since the 1980s. Women now give birth to an average of 1.9 children, down from 2.4 in 2000, according to Brazil's IBGE statistics office.

"The decline in fertility and birth rates is evident and will continue," Alves wrote in an April 21 post for EcoDebate. The pandemic is merely accelerating the trend, he wrote.