(formerly IRIN News) Journalism from the heart of crises

Maternal health worsened since war ended

A heavily pregnant woman is given a routine check-up at a donor-funded health clinic in Monrovia on 20 February 2007. The health system has been devastated by more than a decade-long civil war. According to the World Health Organization, the average life
Tiggy Ridley/IRIN

New statistics showing an increase in maternal mortality since the end of Liberia’s civil war in 2003 have created alarm among health workers who say the country’s almost non-existent healthcare system is to blame.

“We need to have 1,400 midwives and we have about 300,” said Liberian Health Minister Walter Gwenigale. “When you look at the statistics it tells you we need people to do this work. It is obvious that the women who are delivering are not delivering into safe hands.”

The new results, which come from the Liberia Demographic and Health Survey (LDHS) for the years 2006 to 2007, show that deaths among infants and children under five years old have gone down since the last survey was conducted in 1999 to 2000.

However maternal mortality has gone up by about 71 percent with 994 women dying for every 100,000 who give birth, compared to 580 out of every 100,000 women in the previous survey. Doctors say the most common cause of death is vaginal hemorrhaging following childbirth.

Some health workers and officials say the spike is a result of improved data collecting. However others say fewer births are being attended by trained medical professionals, who diminished in numbers through the end of the 1990-2003 war.

Woman power

The government is trying to recruit new health workers and retrain those already working in health to widen the scope of their duties to include obstetrics, Gwenigale said. Of the four medical training facilities Liberia had before the war, only two are currently in operation.


Photo: Tiggy Ridley/IRIN
Children's health has improved in Liberia since the end of the war, but new statistics show maternal health has worsened

One method that is being used to correct this situation is giving basic medical training to traditional midwives, particularly in rural communities where it is nearly impossible for pregnant women to reach a hospital or clinic for delivery.

“Liberia is going through difficulties in its public health system because of lack of manpower, lack of hospitals and clinics and lack of roads which creates delays in getting help. In obstetrics and maternal health, any delay is a big problem,” said Claudette Bailey, the head of the non-governmental health organisation Africare in Liberia.

Bailey said taking healthcare to the communities is “one of the most effective ways” of reducing the mortality rate.

Africare's program is teaching health workers how to train traditional midwives in rural communities to identify pregnancy complications that could threaten a woman's life. Midwives are also being taught to sterilise materials used in delivery to prevent infections and learning how to talk to couples about family planning.

Similar midwife training programs have brought down maternal death rates in countries such as Ethiopia and Tanzania.

Local answers

Tinapu Toby, who has been delivering babies in her small village outside Bensonville for decades, said in some areas of the district pregnant women must walk more than three hours to get to the nearest clinic for prenatal care. Once they are in labor there is often not enough time or no vehicle available to transport them to a hospital, so most give birth at home, she said.

District health officer for Careysburg district Rex Moses said while training local midwives is a good start, the clinics in his district could save more lives if they were restored to their pre-war status, Currently what was the emergency room in his hospital is being used to store furniture as the hospital lacks trained doctors to work there.

''...The government wants these programmes to roll out across the countryside quickly, but rolling out at a speed that would be ideal is just not possible...''

Moses also said a four-wheel drive ambulance could allow rural clinics like his to reach remote areas that are sometimes cut-off when heavy rains make roads impassable.

Government officials and aid workers said while improvements like these and expanding training of midwives would likely help to lower the maternal mortality rate, they are not all realistic given the country's dire needs.

“The government wants these programmes to roll out across the countryside quickly, but rolling out at a speed that would be ideal is just not possible,” Africare's Bailey said.

Because of the amount of work that needs to be done to rebuild Liberia's health sector and infrastructure, it may take up to ten years before Liberia begins to see significant improvement in maternal mortality, Bailey estimated.

kb/nr

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