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HEALTH-LIBERIA: Rainy Season Deadly for Pregnant Women

Bonnie Allen

BAILA, Liberia, Oct 1 2009 (IPS) - As heavy rain hammers the grass thatch roof of her mud hut, Goromah Borbor huddles inside and quietly describes how her daughter Annie died while giving birth.

“When she was in pain, I called for the midwife,” recounts Borbor, fidgeting with a long row of beaded bracelets on her arm. “The girl had started fighting and shaking… then, her lip and mouth and everything started swelling up.”

The Borbor family lives in Baila, a village in central Liberia with three thousand people but no clinic. In emergencies, villagers must travel an hour by car to the nearest hospital, a trip that becomes more difficult during rainy season when roads deteriorate and fewer cars attempt the journey. 

Like hundreds of other women in Liberia every year, Annie Borbor died at home due to complications arising from pregnancy and childbirth. Her infant daughter also died.

“The midwives never told me anything about why the girl was sick,” says Borbor, staring at the rain pouring down.

For every 100,000 births, 994 women died, according to the Liberia 2007 Demographic and Health Survey. The vast majority of women delivered in the community, or in facilities without qualified health workers.

In January 2009, the United Nations Children’s Fund (UNICEF) released a report that indicates a Liberian woman has a 1 in 12 risk of dying due to pregnancy or childbirth complication in her lifetime.

In Baila, on the border of Bong County and Nimba County, pregnant women face many of the most dangerous risk factors for maternal mortality. There is no medical clinic and women must travel long distances on bad roads to receive health care, such as skilled birth attendants, emergency obstetrics, and postpartum care.

Liberia is still rebuilding a health and transportation infrastructure that was destroyed by war between 1989 and 2003. The reconstruction efforts are hindered during wet season, between May and November, when Liberia receives on average 4300 millimetres of rain. It’s one of the wettest countries in the world.

Travelling becomes especially difficult as torrential downpours create huge potholes and wash out roads entirely. Streams and creeks overflow their banks, making footpaths impassable.

Medical studies performed in Senegal, Gambia, and Mozambique have shown significant increases in maternal mortality during the rainy season. Overall, researchers conclude that several factors contribute to the seasonal spike, including a higher rate of malaria and reduced access to health services.

Each Tuesday, Gban Kollie navigates the muddy paths and heavy rains on her long trek to Baila to sell vegetables at market.  “I’m pregnant now, but I don’t know how many months,” explains Kollie, as she wraps a bright gold and burgundy cloth around her large belly. She appears to be eight months pregnant.

Kollie has never seen a doctor or nurse practitioner. She lives deep in the dense rainforest and travels as far as Baila to earn small money to support her family. Going to a hospital would take several more hours by foot, and cost too much money by car.

The tired-looking woman has given birth to ten babies. All of them out in the bush. Seven died.

In her dialect Kpelle, Kollie explains, “Sometimes, when I am delivering my child, I have come through difficulties. One time I delivered a dead child.”

Traditional midwife Tohn Kolleh has delivered babies for 20 years, but acknowledges that emergency cases must go to hospital. The elderly woman says finding a car with space is difficult and expensive. Kolleh knows pregnant women who have died while standing on the side of the road waiting for a ride to hospital. Sometimes, villagers will load the woman into a wheelbarrow or hammock and carry her the distance.

“Some villages are far from the main road. It can take 4 hours to walk,” explains Kolleh.

The Ganta United Methodist Hospital is normally a 45-minute drive from Baila, but it takes longer during rainy season. On the maternity ward, infants wail and new mothers swelter on hospital cots. Assistant supervisor Comfort Neufville loudly chastises pregnant women for not coming to hospital earlier, and consequently, arriving with life-threatening conditions.

Many Liberian women avoid hospital deliveries because they live on less than $1 a day and cannot afford an expensive bill. In Ganta, a hospital delivery costs between $8.50 and $11, plus $2 for each additional day of treatment. The financial strain is amplified during rainy season, also known as “hungry season,” when there are food shortages and price inflation.

“By keeping these women in villages until the end, when complication comes in, that’s the time they come to the hospital,” vents Neufville, practically shouting so the entire maternity ward can hear her lecture. “When you reach here with that complication, to serve the baby and mother, we have to do surgery.”

Haemorrhage, infection, eclampsia, and obstructed labour are the four major killers, according to the World Health Organization. Medical complications that midwives with limited training, in remote villages, are ill-equipped to handle.

UNICEF concludes that about 80 percent of maternal deaths could be prevented with access to healthcare. In Liberia, government reports indicate that sufficient access to healthcare will require more than just medical clinics and more doctors, nurses, and midwives. It will also require better roads and improved educated for girls and women.

Back in Baila, as the rain subsides and the market draws to a close, a pregnant Gban Kollie rejects the idea of staying in the village to deliver her baby. She slowly, and awkwardly, begins her long walk back to the farm, out in the forest, far from the midwife and the limited help that is available. As for Goromah Borbor, she will continue to wonder how the joy of birth turned to misery of death, and the loss of a daughter and granddaughter.