A third of women suffer long-term medical consequences after giving birth. These 9 ‘underreported’ health problems are impacting millions

Nearly 290,000 women around the world die in childbirth each year, and a third of those who survive develop a long-term health issue after pregnancy.

That’s according to the series “Maternal health in the perinatal period and beyond,” published Wednesday in The Lancet Global Health. 

Some of the most common post-pregnancy conditions, which can last for months or even years after birth, include:

• dyspareunia, or pain during sex (affecting 35% of postpartum women)

• low back pain (32%)

• anal incontinence (19%)

• urinary incontinence (8-31%)

• anxiety (9-24%)

• depression (11-17%)

• perineal pain (11%)

• tokophobia, or fear of childbirth (6-15%)

• secondary infertility (11%)

Globally, many women who suffer from postpartum complications live in areas where they can’t access postnatal services, the authors wrote, calling the health issues “largely underappreciated, underrecognized, and underreported.”

“Many postpartum conditions cause considerable suffering in women’s daily [lives] long after birth, both emotionally and physically,” Dr. Pascale Alotey, director of sexual and reproductive health and research at the World Health Organization, said in a Wednesday news release on the series.

“Throughout their lives and beyond motherhood, women need access to a range of services from health-care providers who listen to their concerns and meet their needs—so they not only survive childbirth, but can enjoy good health and quality of life,” he added.

Report: Maternal mortality a ‘flagrant human rights violation’

In 2015, United Nations members set 17 Sustainable Development Goals—“for peace and prosperity for people and the planet”—with an aim of achieving them by 2030. Among sub-goals: Reduce maternal deaths to 70 per 100,000 live births.

In 2020, however—nearly half way to 2030—maternal deaths sat at 223 per 100,000—a far cry from the goal, though down considerably from 339 deaths per 100,000 in 2000.

“The preventable loss of almost 3 million lives of women between 2010 and 2020 is not only a global tragedy, but also an indicator of gross health inequality between and within countries, and a flagrant human rights violation,” researchers wrote.

Since 2016, maternal mortality has decreased in only two of 10 UN regions, according to the series: Central and South Asia, and Australia and New Zealand. It’s stagnated in the majority: Sub-Saharan Africa, Oceania (excluding Australia and New Zealand), East and Southeast Asia, and North Africa. And it’s increased in four regions: Europe, North America, Latin America, and the Caribbean.

When aiming to reduce maternal deaths, public health officials usually turn to medical interventions. Less often do they examine the role of social forces—and this may be why 121 of 185 countries have held the same maternal mortality rates for two decades, the authors contend.

On the list of oft-neglected causes of, and contributors to, maternal mortality:

• gender inequality

• low socioeconomic status

• racism and discrimination

• low maternal education

• disinformation

• living in a rural area

• hunger

• corruption

• armed conflict

• low partner involvement

• suicide

“Maternal health is not just something that we should start worrying about when the pregnancy bump appears,” Joao Paulo Souza, director of the Latin American and Caribbean Center of Health Sciences Information for the WHO and author on one of the papers, said in the release.

This story was originally featured on Fortune.com