Upon assuming the presidency in 2006, Liberia's Ellen Johnson Sirleaf promised to tackle many national problems made worse by a decade of civil war. One of her goals was to curtail the maternal death rate, which has soared to 994 out of every 100,000 live births.
Liberia's maternal death rate remains among the highest in sub-Saharan Africa, but the government is trying to change that. This year, President Sirleaf announced that reducing maternal deaths was among her government's top priorities.
"The ministry of health developed the essential package of health services which describes maternal health interventions at both community level and health facilities level," says Tolbert Nyenswah, deputy minister of health for preventive services. The deputy minister says he is "hearing some positive news about maternal mortality reduction in our country."
Government expands service to mothers and children
Nyenswah names some of the practical steps being taken to protect the lives of pregnant women. He encourages women to seek at least four medical visits before the delivery date to receive needed services such as immunizations.
"Institutional delivery is improving in Liberia, as compared to from 1990. Right now our institutional delivery has increased." Tolbert also urges medical services after the birth for the mother, the new infant and other children in the family for preventive treatment for malaria visits.
Women are also given vaccinations for tetanus and for malaria, he says, which can lead to still births, under-weight babies and even the death of the mother. The government has also expanded access to family planning services to 20 percent of all couples, nearly twice the prior rate.
It is also taking measures to curb complications that can endanger the lives of the mother and baby.
"We have increased services to EMOC - that is, emergency obstetric care and centers - that can provide Cesarean section and other services to mothers. But this cannot be done alone by the Ministry of Health and Social Welfare in Liberia.
"We are integrating with other ministries and agencies including the national legislature, the ministry of rural development ... because of the chiefs and the traditional people in the villages. You know, institutional delivery has increased but there are still 40 percent of people that are still delivering in the facilities and to account for that."
Promoting traditional birth attendants
Another solution to curbing maternal deaths relies on traditional birth attendants. Miatta Fahnbulleh, the government-appointed goodwill ambassador on maternal health in Liberia, describes the support for traditional birth attendants.
"What the ministry of health and social welfare has discovered is that we have our traditional midwives, women who through generations have been giving birth to women. So, why do we not enhance their skills? Why do we not give them the tools to work with? Why don't we give them the information, the basics to help us to reduce that?
"Because really, I don't see how we can build enough clinics. We don't have enough doctors, there are not enough nurses. So ... we must rely on the community and trained traditional midwives."
Dr. Odell Kume, the chief medical officer of Maryland County, says the government has reopened a school to train midwives for the southeastern region in Zwedru. Upon graduation, the birth attendants serve at various clinics within the county for two years. A referral center is available for cases they can not handle.
Midwives are also being trained in Bomi County in Western Liberia.
Dr. Gorbee Logan, the chief medical officer of the regional government hospital, says doctors work closely and meet once a month with trained traditional midwives (TTM).
'More doctors on the ground'
"You know this whole issue of maternal mortality, it has cultural beliefs and practices associated with it," Logan says. "Our people believe that the best people to go to ... are the traditional birth attendants." Doctors "use that opportunity to also train them as well, tell them the danger signs of pregnancy, tell them that facility-based delivery is what the government wants. And every pregnant woman coming by their way, you know, should be referred to the hospital."
Meetings are also held with commissioners, town chiefs and other influential people who help encourage health care among local women. "And, there are now more doctors on the ground to handle emergency referrals from traditional birth attendants," he says.
Logan cites other improvement by the government: new ambulances bring women to maternal clinic, and new and improved health facilities have been built in Maryland County in southeastern Liberia.
"We have 24 health facilities," says Dr. Odell Kumeh of Maryland County and most of them are run by the government. Others are for Catholics and for the Cavallah Rubber Corporation.
The local medical community now anticipates funding for maternal waiting homes for people who live far from the clinic. "If they are nearing delivery, they move there and we have people there to monitor them." If there are complications, they are transferred to a hospital. "We actually need to do that in Maryland County because we don't have any maternal waiting home in the county."
Health care specialists say there are many steps to making childbirth safer for Liberians, including better reproductive health education for girls. Some of the changes are already underway to meet the U.N. Development Goals reducing Liberia's maternal death rate by three-quarters by 2015.