Washington, DC — Liberia has taken another important step towards strengthening its nascent democracy by completing a nation-wide survey which provides a wide range of up-to-date information crucial to formulating good public health policies.
The Liberia Demographic and Health Survey (LDHS), unveiled in Washington, DC this week, provides data on fertility, family planning, childhood mortality, infant and child feeding practices, maternal and child health, maternal mortality, and HIV/AIDS-related knowledge and behavior, as well as HIV prevalence.
The results of the survey were presented by Tornorlah Varpilah, Liberia's deputy health minister, and Anne Cross, the deputy director of survey operations for Macro International, a U.S.-based research organization, at the Woodrow Wilson International Center for Scholars.
Holding up the slim volume which the first such survey produced in 1986, Cross gave a visual demonstration of how much more comprehensive the new report is – it has produced a much thicker volume.
Varpilah, explaining the need for an up-to-date report, cited how he and his team were confronted by "contradictory statistics" when they had tried to draw up proposals for health funding from The Global Fund to Fight AIDS, Tuberculosis and Malaria.
For example, government agencies might give higher, and NGOs lower, figures for the Aids mortality rate – the reason being that high numbers painted a dire picture useful in soliciting funds from donors. Thus statistics were "a power game," he claimed. "The more powerful you were, the more powerful were your statistics."
Now, with the new survey – based on 2007 data – the ministry of health has the figures it needs to draw up its budget and to come up with realistic targets. The data also gives policymakers better insight into what contributes to health threats such as respiratory infections, diarrhea and malaria, which Varpilah cited as the leading causes of infant mortality in Liberia.
On teenage pregnancy, the new LDHS tells us that nearly one in three women aged between 15 and 19 has already begun bearing children, and that young women with no education are more than three times as likely as those with secondary schooling to have started childbearing.
How does this finding relate to birth control? The survey also tells us that knowledge of contraceptive methods has increased dramatically in the past 20 years, with the number of women knowing at least one form of contraception rising from 72 to 87 percent between 1986 and 2007. Knowledge of male condoms has risen from 31 to 79 percent and of injectable contraceptives from 44 to 74 percent.
With such data, health researchers can now ask why the use of contraceptive pills has dropped from the six percent reflected in the 1999-2000 LDHS to four percent in 2007. A good guess, according to Anne Cross, may be that more women are now comfortable with injectables.
The new report is not without its critics. Hannah Guedenet, communications associate with Macro International, said the Liberian health ministry has contested findings on child vaccinations. The ministry estimated that as many as 85 percent of children of between 12 and 23 months had been vaccinated. But the study says that nationally only 39 percent have received all recommended vaccines – and that the figures in urban and rural areas respectively are 53 and 33 percent.
The most controversial parts of the report, however, have to do with the prevalence of HIV infection, which was measured by testing almost 12,000 men and women. The prevalence among adults aged between 15 and 49 was 1.5 percent – 1.8 percent for women and 1.2 percent for men – quite low compared to other African countries. The higher prevalence among women correlates with a finding that 10 percent of women reported that their first sexual intercourse was forced upon them against their will.
Anne Cross suggested there was a link between low prevalence of HIV and the finding that 98 of Liberian men are circumcised. Recent studies show that male circumcision reduces HIV infection. She also said the figures may reflect testing methods – normally researchers used rapid test methods, which gathered rates from urban health centers, while the LDHS interviewers used another testing method.
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Varpilah also shed some light on the issue by noting that Liberia's wars had immobilized many of its people, impeding the migratory patterns that have accelerated the spread of the virus in other parts of the continent. When a member of the audience pointed out similar trends in post-conflict societies such as Mozambique and Angola, Varpilah warned that "we cannot be complacent… The opening up of a post-conflict country can accelerate the spread of the HIV virus in a short time."
A nationally-representative sample of 7,092 women and 6,009 men aged between 15 and 49 was interviewed for the LDHS. It is the third Demographic and Health Survey conducted in Liberia and was sponsored by the United States Agency for International Development (USAID) and the Liberia Institute of Statistics and Geo-Informational Services. Other sponsors include the United Nations Population Fund, the United Nations Children's Fund and the UN Development Programme.
