First-Hand Look into Liberian Maternal Health Clinics

Last month I had the opportunity to visit a maternity clinic in rural Liberia, West Africa while working on a documentary that I’m producing on trauma healing in a nation devastated by 14 years of civil war. But as I saw first-hand, mental health is often inextricably linked with pregnancy in post-war countries like Liberia. And the task of improving maternal health care in the wake of a prolonged, bloody conflict is fraught with challenges.

Liberia has one of the world’s highest ratios of maternal mortality; 994 per 100,000 live births. Every day, four women die in Liberia from complications related to childbirth or pregnancy.  Last year, President Ellen Johnson Sirleaf announced a five-year plan to reduce this rate by half. It’s a laudable goal, but also an ambitious one.

I visited women in a clinic located at Ganta United Methodist Hospital in Nimba County, northern Liberia, who told me they had walked between two and five hours that morning to reach the hospital. Ganta, which benefits from the USAID-funded Nehnwaa Child Survival Project, is a referral site for pregnant women suffering from complications (the vast majority of women in rural Liberia give birth at home).

The waiting area was packed with more than four-dozen expectant mothers, sweating in the sub-Saharan heat and holding their swollen stomachs. Some had raw blisters covering their feet. Others were in visible pain; a frightened 18-year-old named Dinjana told me she had just walked more than two hours with severe abdominal aches. A young woman named Korto, just five months pregnant, said she had such sharp back pain that she walked three hours to reach the clinic and would wait all day to see a doctor.

Access to care is one of Liberia’s largest impediments to reducing maternal mortality. Fourteen years of war wiped out the country’s health infrastructure and its roads. The devastation drained the country of skilled birth attendants and emergency obstetricians. The remaining specialists are hard to reach; roads in rural Liberia are unpaved and pockmarked with muddy, cavernous potholes. The roads are impassable during the country’s rainy season, leaving thousands of women to die at home from obstetric complications. 

One effort to reach expectant mothers in remote areas of Liberia is being led by Jody Lori, a clinical assistant professor at University of Michigan’s School of Nursing. Jody has been working on maternal health issues in Liberia since 2006. Now, backed by a grant from USAID, she and her team are evaluating the impact of a handful of newly constructed maternity waiting homes. These homes, built close to primary care facilities, allow expectant mothers at any stage of pregnancy to check in and remain in the care of a trained midwife until their delivery.

At the end of my day at Ganta Hospital I returned to the maternity clinic. The sub-Saharan sun was beginning to set, and only about a dozen women remained in the waiting area still hoping to be seen. Most of them were lying on the wooden benches, resting in anticipation of what would likely be a long—and potentially life-threatening—journey home.