22 UNMIL FOCUS June - August 2007

By Sulaiman Momodu

At the Redemption hospitalin Monrovia, JoanaDenmia, 25, has deliveredtwins. “My parentsbrought me to this hospital

because I was very sick,” she says, busybreastfeeding her babies. “This is my fifthborn. Two of my children died before theage of five.” Though anaemic and com-plained of bodily pains, Denmia was luckyto have given birth safely. Next to her bedin the maternity ward, Ruth Jallah, 28,says she was admitted to the hospitalbecause she was bleeding profusely, whichcaused her five-month-old pregnancy toabort. “This is my second miscarriage,”she lamented.

For many Liberian women, especially

those living in the rural areas, realizing thedream of motherhood can be risky. Oneout of every 16 women dies while givingbirth in Liberia. In the developed world,only one out of 3,800 women faces such atragedy. Beyond the risk of women losingtheir lives while giving birth, one in everyfour children in Liberia also dies beforethe age of five.

Among the causes of maternal deathsin Liberia are hemorrhage, hypertensivedisorders of pregnancy, unsafe abortion,prolonged or obstructed labour,Infection/sepsis; other direct causesinclude malaria, AIDS, and anaemia. Thehighest cause of child mortality is malaria,accounting for about 42 per cent of cases,followed by diarrhoea with 22 per cent,and acute respiratory infections account-ing for about 12 per cent, according to

Ministry of Health (MoH).As Liberia emerges from the devastat-

ing civil war that destroyed much of thecountry’s infrastructure, including hospi-tals and clinics, improving maternal healthand reducing child mortality -- two of theeight UN Millennium Development Goals(MDGs) -- are among the priorities of thegovernment. The United NationsChildren’s Fund (UNICEF), the WorldHealth Organization (WHO) and UnitedNations Fund for Population Affairs(UNFPA) are among the organizationssupporting the government’s efforts. Thetask ahead, however, is enormous.

In addition to destroying the healthfacilities across the country, the civil waralso took the lives of several medical pro-fessionals. Many others fled the countryduring the war and are reluctant to return

The Agony of ChildbirthImproving mat

June - August 2007 UNMIL FOCUS 23

home due to poor working conditions andfacilities. Today, Liberia is faced withacute shortage of qualified medical staff tomeet the health needs of the population.

Dr. Eileen Reilly of ScottishInternational Relief, who works at thegovernment hospital in Tubmanburg, isthe only gynaecologist for the populationsurrounding the area. There is just onegovernment doctor in the hospital. “Wehave only one ambulance serving threecounties…most times pregnant womencome to the hospital bleeding and almostat the point of death. The maternal healthsituation here is absolutely appalling,” shelaments. Without the voluntary medicalassistance rendered by the Pakistani doc-tors stationed in Tubmanburg who alsoprovide free drugs, the operation of thegovernment hospital will be a nightmare.

In some towns and villages, pregnantwomen and other sick people have toeither walk or be transported in ham-mocks. In Grand Kru for example, whichis referred to as the “Walking County,”

medical personnel say a woman in labourhas to walk for days to reach a health facil-ity. Compounding the scenario is the highprevalence of teenage pregnancy in thecountry.

To help improve the delivery of med-ical care across the country, the UnitedNations Mission in Liberia (UNMIL) hasfunded 15 newly-built or rehabilitatedhealth facilities in eight counties throughits Quick Impact Project. “Health iswealth. We must help you generate thiswealth. Without healthy children, therewill be no healthy Liberia,” says AlanDoss, the Special Representative of theSecretary-General. Peacekeepers alsocarry out medical outreach activities intowns and far flung areas, sometimestrekking for miles to render free medicalassistance to the ailing.

“There are a lot of gaps in servicedelivery in addressing emergencies thatkill our mothers…having skilled person-nel in service delivery is key to reducingmaternal and child mortality,” says Dr.Musu Julie Conneh-Duworko, the FamilyHealth and Population Adviser at theWHO. The organization is supporting thegovernment in its drive to improve healthdelivery across the country. It has provid-ed both financial and technical support forthe development of the “Maternal – newborn health road map,” which defines thevision of the government to address thesituation of maternal and child healthissues.

The MoH is putting in place a strategyto accelerate child survival in the comingyears through interventions that are highimpact and low cost. Dr. Isabel Simbeye,the Project Officer, Health and Nutrition atUNICEF, says the UN agency helps withtechnical support, equipment, drugs andtraining. In areas that are inaccessible byvehicles and motorbikes, health personneluse bicycles or trek several miles in orderto render medical services and to sensitizepeople on healthy living.

In Foya district, Lofa County, theWHO, in collaboration with UNFPA andthe MoH, has introduced “appropriatetechnology ambulances.” They are motor-bikes with a cushioned carrier fixed to it totransport pregnant women to the nearestfunctional health facility. The pilot projectis called “Wolorkendia,” a Kissi word for

safe birth. Currently there are 364functional

health facilities in Liberia, including hos-pitals, heath centres and clinics. By andlarge, deliveries in health facilities arevery low and are sometimes done by tradi-tional midwives or trained traditional mid-wives (TTM), who are not competent tohandle complex cases. Health authoritieshave begun training middle-level healthworkers to ensure they are well equippedto carryout their functions. The MoH andpartners work with TTMs in the communi-ties to improve their skills and encouragethem to refer cases. MoH, in collaborationwith partners, is also undertaking immu-nization to prevent child mortality.

Now that Liberia is moving from anacute humanitarian situation to one ofrecovery, some non-governmental organi-zations which came to the country’s assis-tance during the height of the civil crisis torehabilitate health facilities and carry outfree medical services are folding up theiroperations, a development that is of greatconcern to the government. Efforts arebeing made to fill the gap when many ofthe organizations would have finallypulled out by 2008. Working conditionsare also being revisited to make them moreattractive so that doctors and other medicalpractitioners can move from the city to thecounties.

One of the major challenges of theLiberian health sector is the lack of statis-tics. MoH officials say they are puttingtheir records in order. Meanwhile, a justreleased 2007 Liberia Demographic andHealth Survey (LDHS) points to encour-aging trends in maternal and child health.

The survey shows that the current fer-tility rate in Liberia is 5.2 children perwoman, down from 6.2 children in1999/2000. The under five mortality hasbeen cut in half to 111 from 219 deaths per1,000 ‘10 to 14 years before the survey.’During pregnancy, 79 per cent receivesanti-natal care from a health professionaland 78 per cent of births are protectedagainst tetanus. However, only 39 per centof children are considered fully immu-nized against childhood killer diseases.

Despite the marginal progress beingmade, much remains to be done toimprove maternal health and reduce childmortality in Liberia.

ternal health is a major priority in Liberia

MATERNAL HEALTH