Norris Town — The physical challenges of pregnancy are difficult for women everywhere. But in rural Liberia pregnancy is dangerous.
Sando Kollie learned this the hard way earlier this year. As the 20-year-old approached her March due date with her second child, Sando had already had to walk her heavy body an hour and a half each way for check ups at the only government clinic near her small rural village here on the St. Paul River, northeast of Monrovia.
So when Sando went into labor in the middle of the night her family set out to walk her to the clinic. But she couldn't make it.
"It was at 4 am. My stomach was hurting me badly and the road was far. I told my mom that I could not make it any longer," Sando recalls sadly. "I fought... fought and fought, there was no way. That's how the people (family) spread the cloth on the ground. So that's how the dead baby came outside. I feeling bad, yea... and I was going to the clinic for treatment and all, they were treating me, but I don't know what is the cause that type of thing happened to me."
Sadly Sando's experience is common in rural areas across Liberia. Though it has made progress the country still has one of the world's highest rates of maternal mortality. Three women die every day in childbirth according to a survey by United Nations agencies and the Ministry of Health. That's 1,100 women a year. More than 8,500 babies die. The high numbers prompted President Joseph Boakai to express his sadness in a meeting with UN partners earlier this month.
"It is a shame to us as a society and we feel guilty that this is happening in our country," said President Boakai. "And this is a symptom of a society that has been insensitive to the real issues affecting its people... We appreciate your coming and can assure you that this is going to be a record of the past."
Many people will be working to keep the president to his word. Debbie Kwashie has witnessed too many of these heartbreaking deaths in her role as Officer-in-Charge of the Arthington Clinic. Four pregnant women died a year ago while en route to the clinic to give birth from Sando's own village. Arthingthon is historic - known as one of the first settlements of free slaves from the Americas in the 1800s - but that has not saved it from the neglect seen across the country.
"There is no maternal waiting home as we speak," Kwashie says. "Patients come from way Blackablah, Bukestown, and nearby towns in pain and sometimes they deliver on the highway before they reach us."
Kwashie says the shortages in the clinic are critical. The staff quarter has no electricity and during the rainy season the roof leaks. This situation has discouraged professional nurses from taking up assignments at the clinic.
"This facility needs attention, there are lots of challenges, and there are a lot of things that we need in that facility. There is no delivery set ... look at the leakage in the building. We are understaffed - no dispenser, we are only two professionals in the building," Kwashie says.
The Ministry of Health denies the numbers are as bad as the medical staff in Norris Town report.
Felicia Gbesioh, head of communications at the Ministry, said Dr. Nowiah Garpudolo-Dennis, Director of the Family Health Division of the Ministry, refused to comment directly on the issue but passed on her concerns through Gbesioh.
"Based on the information you gathered from your investigation from the rural area, she (the Director) couldn't respond because they (the numbers) are so, so very far from the truth as compared to the data we have as a ministry," Gbesioh said.
Despite repeated text messages and emails asking for the numbers she claimed the Ministry had, Gbesioh did not provide the data to FrontPage Africa/New Narratives before press time.
After a decade of crises besetting Liberia's health workers including Ebola and Covid staff have very clear ideas about what will curb maternal deaths.
"One of the things we are advocating for is for all facilities to have a maternal waiting home for pregnant women," said Edwina Sheriff, the women's wing chair of the National Health Workers Union. "Because when that building is there, when the woman reaches the ninth month, she will come there and be there until she can give birth. But we have that as a big shortage in Liberia." Sheriff said provision of ambulance service, drugs, and staff quarters will bridge the gap in obstetric care between rural areas and urban areas.
"We need more trained midwives and nurses in the rural areas that will be paid well," says Richeal Strother, a trained midwife who has worked in rural Liberia for more than a decade. "We need ambulances. We need to see that our roads are in good condition and that our patients can easily access the health facility, at all times, they should have the right to health the same way people in Monrovia have the right to health."
Most development experts agree that investments in health and education will reap that most rewards. Liberia is a signatory to several international treaties on health spending including the "Abuja Accord" which calls for a 15 percent allocation to the health sector in the national budget. But Liberia has never matched that.
The Boakai administration has lifted the budget for health from about $US75 million or 9.7 percent of the 2023 budget to US$80.50 million or 10.8 per cent in 2024. It's still a drop in the bucket. The 2024 Health budget equates to about $15 per Liberian per year. For comparison the United States spends $US11,000 per person per year. The system is heavily reliant on donor funds.
There are 924 doctors currently serving the population of 5.2 million Liberians, according to the World Health Organization. The doctor to patient ratio is 1:5,000 - a number which is far below WHO recommendation of one doctor to 1,000 patients, considered the minimum for adequate healthcare.
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Health workers say corruption is a huge problem. Funds allocated to rural communities do not always make it. One example of theft of donor funds at the Bomi Mines hospital was exposed by Front Page Africa in 2023. Such corruption can slow donor funds or end them.
"We observed that there was a little increase but then, how much is there for the rural areas?" asked Sheriff of the Health Workers Union. "Whenever the budget is made, they say, maybe we give $80 million to health. How is it expended? We don't know. Where does it go? What do they use it for? We don't know."
Local representative Hon. Bernald Blue Bension, of District #17, Montserrado County, applauded the increase in the health budget and committed to making it effective.
"Now, we must also check the process to make sure those allotments reach where it supposed to reach, reminding then that for the situation to be sustainable, the government must intervene and make areas like Arthington a priority," said Bension.
In the meantime, Sando and other women here worry that future pregnancies will end the same way as her last - in the death of her baby and maybe herself.
This story was a collaboration with New Narratives as part of the "Investigating Liberia" project. Funding was provided by the US Embassy in Liberia. The funder had no say in the story's content.
