Every day in sub-Saharan Africa about 550 women die due to complications of pregnancy and childbirth. On average, 1 out of 13 women die every day in Africa while trying to become a mother.
Liberia is no exception, with 1,072 maternal deaths for every 100,000 live births. In 2015, the country was designated one of the “fragile” countries targeted by the Global Financing Facility and is currently ranked tenth in the world for maternal mortality.
These deaths are tragic because they result largely from preventable complications that arise during the critical period of labor, delivery, and the immediate 24 hours after giving birth. These complications go untreated because women have poor access to health services and often have to walk long distances and through rough terrain to get to a health facility, with little to no transportation options or support.
In some cases, they are referred too late to a health facility for safe and assisted delivery. Liberia’s mortality figures are alarming.
To address one of the enormous challenges these women face, Africare and the University of Michigan developed an approach to overcome the distance barrier for women living in some of the most remote regions.
From 2010-15, Africare and the University of Michigan, with the support of the Ministry of Health (MoH) and with funding from USAID (United States Aid for International Development), developed a partnership to design, construct, and evaluate the first Maternity Waiting Homes (MWHs).
MWHs are residential dwellings near health facilities where women in the late stages of pregnancy can stay to await delivery and receive care after giving birth. MWHs have been used in a variety of settings as a “geographic bridge” to overcome distance and transportation barriers that can prevent women from receiving obstetric care in a timely manner. Since the first sets were constructed, more than 100 homes have emerged around the country.
In light of this, Africare-Liberia, the University of Michigan and the MoH convened a key stakeholders meeting on May 22 at the Phebe MWH in Bong County, to present preliminary findings from an assessment of 130+ waiting Homes.
The study was funded by the Bill and Melinda Gates Foundation. The meeting brought together Joyce Wahzugbalia Dunbar-Sherman, Deputy Health Minister for Preventive Services, Mrs. Faith Akovi Cooper, Africare’s Country Director for Liberia and Ghana, Dr. Collins Saa Bowah, Bong County Health Officer, Dr. Jefferson Sibly, Medical Director of Phebe Hospital, Dr. Jody Lori, Associate Dean of Global Health, University of Michigan, Dr. Francis Obuseh, Executive Director, FSHS and Nutrition Epidemiologist, Dr. Jacob Anankware, Lecturer, Department of Hoticulture and Crop Production, School of Agriculture and Technology, University of Energy and Natural Resources in Ghana and Dr. James Barclay, Medical Director of Africare as well as two local government officials of Bong County.
There were also doctors, nurses, public health practitioners from the Phebe Hospital and the County Health Team, Trained Traditional Midwives (TTMs) and stakeholders who are committed to safe motherhood in their respective communities.
Mrs. Cooper meanwhile reaffirmed Africare’s commitment to support the government of Liberia’s effort in reducing maternal mortality.
She said pregnant women often have to travel long distances to reach the nearest health facility, making it difficult for them to get the care they need.
Mrs. Cooper told the gathering that in fact, in Liberia, distance challenge is considered one of the leading factors contributing to the country’s high maternal mortality ratio. She also stated that Africare has a long history working in Liberia, with 25 plus years in the areas of Health, Agriculture, Youth and Women empowerment, all areas that are critically important to advance the lives of Liberians.
She commended the support from the County Health Teams and community partners and urged the group not to only identify the challenges, but to develop set recommendations towards addressing maternal mortality in Liberia.
Dr. Bowah recounted his personal stories of providing medical care to pregnant women who sometimes come to the health facility too late, after several attempts of trying to deliver at home and in most cases, the health facility was able to intervene and save their lives.
Bowah emphasized the need for a well-coordinated government approach, to address the issue of maternal deaths. He outlined challenges and proposed recommendations, including sustainability and empowerment of local communities to both effectively manage the waiting homes and its operations through creative entrepreneurial activities, but also integrating the TTMs into sustainability plans.
“If we want to succeed in our quest to reduce maternal mortality, we must make the TTMs our friends,” Dr. Bowah suggested. Dr. Lori echoed his suggestion by emphasizing the importance of integrating the TTMs into community approaches, which are critical steps towards reducing pregnancy-related deaths and other complications to safe motherhood.
Lori also revealed that the University Of Michigan School Of Nursing in partnership with Africare constructed the first set of MWHs in the country, which are highly cost-effective, “but it is necessary to make strategic and affordable plans to reduce maternal mortality,” Dr. Lori challenged.
She then presented the preliminary findings, which set the stage for development of a blue print on construction, management and sustainability of waiting homes across the country as a strategy towards promoting safe motherhood.
“No woman should have to die while giving birth,” she said.
One of the critically important aspect of the waiting homes is the presence of a trained midwife, such as Viola Makor, Certified Midwife and Reproductive Health Supervisor, who shared her personal story and committed to promoting safe motherhood.
Madam Makor highlighted successes and challenges at the waiting home, indicating that since the establishment of the Phebe MWH in 2013, it has admitted 645 mothers and in total 715 live births as some have given birth to twins and triplets.
“There are challenges associated with the maintenance and sustainability of the waiting home,” Makor stated, noting that women are expected to bring their own food and often times it is a challenge if they have limited resources with other children at home to take care of.
Joining Viola were two beneficiaries who highlighted the impact of the homes on their lives. One of them said she had delivered three times with support from the waiting home, but said she would not have had successful C-sections without the Home, community support and the hospital.
This important meeting concluded with an interactive panel involving four panelists/facilitators led by Dr. Obuseh, Dr. Jacob, Ms. Makor and Gormah Cole (“Mother dear”).
The discussion was aimed at outlining the way forward for long term sustainability, specifically developing plans to address the food crisis. The panelist will continue to explore immediate and long-term solutions to address the challenges associated with the waiting home.
In closing, Minister Sherman praised Africare for the laudable initiative to construct MWHs as part of efforts to join the fight to reduce maternal mortality.
She also said the government will continue to work with partners in providing the needed services for its citizens whether in health, agriculture or in education.
“We don’t have a choice whether we are born a male or female at birth, but we do have a choice to make a difference in society,” Mrs. Sherman said.
Meanwhile, Africare, University of Michigan and MOH will launch a final report later this year from the assessment of 100+ homes across Liberia.