Liberia's obstacles toward better maternal care

A woman’s wellbeing during pregnancy and childbirth should not be dependent on her economic status. Sadly, poverty fuels many maternal deaths in impoverished African regions. In Liberia, there are more than 1,200 maternal deaths annually, most of which are preventable with proper medical attention. With a broken healthcare system, Liberian women of childbearing age are left to fend for themselves and their vulnerable newborns. For women living in rural areas, pregnancy is life-threatening and terrifying – a far cry from the special experience it should be.

Most maternal deaths are attributed to preventable and treatable pregnancy complications; however, the real issue is that many women do not have access to emergency obstetric care. In all of Liberia, there are only three qualified obstetricians and 412 midwives available to treat nearly two million women of childbearing age. A study by UNFPA estimates that 74% of global maternal deaths could have been averted if all women had access to obstetric care. Women should have a right to emergency obstetric care, skilled birth attendants, sexual education, family planning services, and primary health care services. At John F. Kennedy Hospital in Monrovia, one of Liberia’s biggest hospitals, beds are in high demand and short supply. In an interview with IRIN, Dr. John Mulbah, head of the maternity center, pointed out the hospital’s limited resources. “We have only five staff trained to conduct fistula treatment. The unit has only 30 beds. . . Our facility is overwhelmed with patients and some have to wait for a long time before being attended to.” Liberia’s severely overwhelmed and understaffed maternal healthcare system deprives women of their right to basic health services.

Further, many women cannot access their healthcare system because they are poor and have no means to travel to the nearest clinic, outside of their rural settings. Because of the lack of roads, some pregnant women are forced to walk three hours or more to the nearest clinic for prenatal care – now imagine undergoing the same ordeal while in labor. Ellen David, a 17 year old resident of Monrovia, knows this all too well. Her baby died because she had no money for maternity bills, clinics weren’t open at night when she went into labor, and the curfew imposed in the light of the recent Ebola outbreak meant she couldn’t have gone to a hospital even if she had the means to. “It’s an awful pain. You look to cuddle your bundle of joy and it dies. You want the ground to swallow you up,” explained Deddeh Howard, neighbor of David. In order to address this issue, Africare was established as a nongovernment health organization targeting traditional midwives. Africare developed a program that trains traditional midwives how to identify and treat potentially life-threatening pregnancy complications. Since traditional midwives are so commonplace in rural communities, educating these midwives goes a long way in countering the dangers associated with traditional birth delivery.

Why is it important to talk about maternal care in countries like Liberia? In Liberia, women are a vital part of society. They account for roughly 55% of the economy, making up 80% of trade, 60% of agricultural output, and the vast majority of household chores. Additionally, they are entrusted with caring for children and therefore, are socially responsible for fostering the next generation of healthy, able-minded citizens. Despite the woman’s important contributions toward society, she remains disadvantaged and disenfranchised by the government. Many maternal care interventions are highly effective in reducing maternal deaths, cost-effective, and ultimately cost-saving. They yield return investments of over 100% in the long term run because healthy women are able to contribute to society. Preventable maternal mortality is not only an issue of development, but also of human rights. By empowering women through health, governments can ensure additional economic benefit as a direct result of their survival and ability to become a productive member of the workforce.

There are no simple solutions – we cannot wait for poverty to disappear in the background and expect maternal mortality to decrease; small steps must be taken toward the ultimate goal of creating a sustainable maternal care system. Some of the biggest challenges faced are government accountability and fiscal responsibility. We need to encourage governments to take initiative to support their citizens with public programs such as education, health, water, and transportation. These very basic services we take for granted in Western countries go a long way toward creating a healthier, more productive society. If we want to tackle maternal mortality, we need to build up pressure for government accountability and encourage sustainable reformations in the health sector and infrastructure. These changes will require an enormous amount of work and funds, but ultimately will result in better maternal care in developing countries.

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