Liberia: In rural areas, birth means risk of death

Norris Town — The physical challenges of pregnancy are difficult for women everywhere. But in rural Liberia, pregnancy is dangerous.Sando Kollie learned that the hard way earlier this year.

As the 20-year-old neared her due date in March with her second child, Sando had already had to walk her heavy body an hour and a half each way for check-ups at the only government clinic near her small village here on St. Paul River, northeast of Monrovia.

So when Sando went into labor in the middle of the night, her family set out to follow her to the clinic. But she couldn’t handle it.

“It was 4 o’clock. My stomach hurt and the road was long. I told my mother I couldn’t take it anymore,” Sando recalls sadly. “I fought… fought and fought, there was no way. That’s how people (the family) spread the cloth on the ground. So that’s how the dead baby came out. I felt bad, yes… and I left to the clinic for treatment and everything, they treated me, but I don’t know what is the reason that this kind of thing happened to me.”

Unfortunately, Sando’s experience is common in rural Liberia. Although it has made progress, the country still has one of the world’s highest maternal mortality rates. Three women die every day in childbirth, according to a study by UN agencies and the Ministry of Health. That’s 1,100 women a year. More than 8,500 babies die. The high numbers prompted President Joseph Boakai to express his sadness at a meeting with UN partners earlier this month.

“It is a shame for us as a society and we feel guilty that this is happening in our country,” President Boakai said. “And this is a symptom of a society that has been insensitive to the real issues affecting its people… We appreciate your coming and can assure you that this will be a record of the past.”

Many people will work to hold the president to his word. Debbie Kwashie has witnessed too many of these heartbreaking deaths in her role as an officer at the Arthington Clinic. Four pregnant women died a year ago while on their way to the clinic to give birth from Sando’s own village. Arthingthon is historic – known as one of the first settlements of freed slaves from America in the 1800s – but that hasn’t saved it from the neglect seen across the country.

“There is no mother waiting at home as we speak,” says Kwashie. “Patients come from Blackablah, Bukestown and nearby towns with pain and sometimes they deliver on the motorway before they reach us.”

Kwashie says the shortage at the clinic is critical. The staff quarters have no electricity and in the rainy season the roof leaks. This situation has prevented professional nurses from taking on duties at the clinic.

“This facility needs attention, there are lots of challenges and there are many things we need to use in that facility. There is no delivery kit … look at the leakage in the building. We are understaffed – no dispenser, we are only two professionals in the building,” says Kwashie.

The Department of Health denies that the numbers are as bad as the medical staff in Norris Town are reporting.

Felicia Gbesioh, Head of Communications in the Ministry, said Dr. Nowiah Garpudolo-Dennis, director of the family health department in the ministry, refused to comment directly on the issue but relayed his concerns through Gbesioh.

“Based on the information you gathered from your survey from the rural areas, she (the director) could not answer because they (the figures) are so, so far from the truth compared to the data we have as a ministry,” Gbesioh said.

Despite repeated text messages and emails asking for the numbers she claimed the ministry had, Gbesioh did not provide the data to FrontPage Africa/New Narratives by press time.

After a decade of crises affecting Liberia’s health workers, including Ebola and Covid workers, have very clear ideas about what will curb maternal deaths.

“One of the things we’re advocating is for all facilities to have a waiting room for pregnant women,” said Edwina Sheriff, the president of the women’s wing of the National Health Workers Union. “Because when that building is there, when the woman reaches the ninth month, she will come there and be there until she can give birth. But we have that as a great shortage in Liberia.” Sheriff said the provision of ambulance service, narcotics and staff quarters will bridge the gap in obstetric care between rural and urban areas.

“We need more trained midwives and nurses in rural areas who will be paid well,” says Richeal Strother, a trained midwife who has worked in rural Liberia for more than a decade. “We need ambulances. We need to see that our roads are in good condition and that our patients can easily access the health facility at any time, they must have the right to health the same way the people of Monrovia have the right to health”.

Most development experts agree that investments in health and education will reap the greatest dividends. Liberia is a signatory to several international treaties on health spending, including the “Abuja Agreement,” which requires a 15 percent allocation to the health sector in the national budget. But Liberia has never matched it.

The Boakai administration has increased the budget for health from about US$75 million or 9.7 percent of the 2023 budget to US$80.50 million or 10.8 percent in 2024. That is still a drop in the bucket. The health budget for 2024 is equivalent to about $15 per Liberian per year. By comparison, the US spends USD 11,000 per person per year. The system is heavily dependent on donor funds.

There are 924 doctors currently serving the population of 5.2 million Liberians, according to the World Health Organization. The doctor-to-patient ratio is 1:5,000 – a figure far below the WHO recommendation of one doctor per 1,000 patients considered the minimum for adequate health care.

Health workers say corruption is a major problem. Funds allocated to the rural communities do not always reach. An example of the theft of donor funds at the Bomi Mines hospital was exposed by Front Page Africa in 2023. Such corruption can slow down or terminate donor funds.

“We observed that there was a small increase, but how much is there for rural areas?” asked the sheriff of the Health Workers’ Union. “When the budget is made, they say, we might give $80 million to health. How will it be spent? We don’t know. Where will it go? What will they use it for? We don’t know.”

Local representative Hon. Bernald Blue Bension, of District #17, Montserrado County, applauded the health budget increase and pledged to make it effective.

“Now we also need to control the process to ensure that these allocations reach where they should and then remind that for the situation to be sustainable the government needs to step in and prioritize areas like Arthington,” Bension said.

Meanwhile, Sando and other women here worry that future pregnancies will end the same way as her last—in the death of her baby and perhaps herself.

This story was a collaboration with New Narratives as part of the “Investigating Liberia” project. Funding was provided by the US Embassy in Liberia. The funder had no influence on the content of the story.

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