Nimba County — When Amelia Nyanamah entered the eighth month of her pregnancy her village midwife advised her to go to the nearby maternal waiting home for a safer delivery. The 38-year-old mother of four had already made the arduous 10-kilometer trip by foot from her remote village to the Lugbeyee Clinic waiting room when she gave birth to her fourth child in 2020. She thought she knew what to expect.
But when she reached the clinic this past November, four years later, things had changed. There was no food, no soap for washing, no clean linens on the beds, and worst of all-- none of the common medicines used during labor. Amelia wanted to leave.
"Our husbands them are the one who can provide food for us," Amelia says.
Between 2010 and 2018 the government of Liberia and partners - mainly the United Nations Population Fund - built 119 maternal waiting homes across Liberia, 19 in Nimba alone. The idea was to combat Liberia's extremely high maternal and infant death rates and to provide sexual and reproductive health care.
The midwife here says mothers are now hesitant to come preferring instead to risk giving birth with no medical help if things go wrong. Doctors and health experts say that risks the lives of both mothers and their newborn babies. It is also leading to birth injuries for babies and mothers, such as fistulas, that impact the rest of their lives.
Liberia's alarmingly high maternal and infant mortality rates became a major focus of development efforts after the war. As recently as 2014, four women died in childbirth every day. Liberia has made some progress: a survey by United Nations agencies and the Ministry of Health in 2015 found that the rate had been lowered to three women dying a day. But Liberia still has one the world's highest rates of maternal mortality. About 1,100 women and more than 8,500 babies die each year. The high numbers prompted President Joseph Boakai to express his sadness and commitment to tackling the issue in a meeting with UN partners shortly after taking office in January 2024.
The former administration of George Weah which ruled from 2018 to 2024 saw large parts of government grind to a halt as funding slowed. Several government officials were recommended for prosecution by Liberia's independent audit commission. Rural health has been one of the sectors impacted. But 11 months into the new government people here say they have yet to see a change. Experts say Liberia's progress is going backwards.
Experts Say Maternal Mortality Progress is Slipping
At Zorgowee Maternal Waiting Home in Nimba's Gbehlay Geh Health District, Edwina Ben, sits heavily on a wooden chair. Her baby is due any day. She lives in Zualay Town, a four-hour walk from here.
Edwina's midwife also told her not to risk going into labor at home. But she wants to leave.
"The things them that supposed to be here to make me feel good is not here," says Edwina. "The food and dishes them that supposed to be here they are not here. I want to go to my husband because he is the one feeding me. Nobody feeding me here."
Marion Y. Dahn, a midwife at the Lugbeyee Maternal Waiting Home, says the conditions are dangerous and mothers are staying away.
The midwife says she has limited access to essential drugs like antibiotics and oxytocin, a hormone that keeps the body pushing the birth along when it has stalled. Without it many babies and mothers can die or suffer injuries. Madam Dahn says she has had to resort to buying the medicines herself.
"We need oxytocin in the delivery room. We need RL (hydration fluid) but they are not there," says Madam Dahn. "I will not wait to say because government did not put it here so I will not work. So, I don't want to lie, when the fluid is not there, I can buy it and sell it to the pregnant women when they are in labor."
Karntay Deemie, health services director for Nimba County Health Team, acknowledged that maternal rooms are facing challenges. In an interview, he conceded the widespread lack of necessities is leaving women vulnerable, but he blamed that on the numbers of pregnant women coming to the homes in Nimba County.
"Mothers will come and sometimes they are there for a whole month," says Mr. Deemie. "Within one month, you will see that more than 30 persons had visited a maternal waiting home, using the mattresses. Those mattresses that are manufactured these days have problems."
Mr. Deemie denied there was shortage of drugs.
"Just this quarter that we are in, drugs had been distributed," Mr. Deemie says. But he could not confirm oxytocin was among the supplies. Mr. Deemie says people should not expect the government to provide for women waiting to give birth.
"Those people should be supported by their husbands and parents," says Mr. Deemie. "You know that if we have 19 maternal waiting homes, let us take 20 persons to be in each area, and you are sending 20 bags of rice to every area. It will not be sustainable. So, the husbands and parents should do the feeding."
The director called for coordinated efforts from all stakeholders to mitigate the challenges.
"In the whole republic there will be no area without challenges, but the only thing we can do is to work together towards the challenges that have been identified so that we can solve the problems," Mr. Deemie says.
Ayouba Mohammed Konneh, secretary general of the Liberia Midwives Association, rejected Mr. Deemie's claims. He says the problems in Nimba are common across the country.
"Many of the maternal waiting home centers across the country in recent times, you will find that majority of them are lacking even beds, bed linens, no food. The facilities are underfunded," says Mr. Konneh. He blamed the government's failure to include maternal waiting homes in Liberia's National Health Plan. (The plan outlines the strategies, objectives, and resources for improving the health sector in the country.) "The facilities are forgotten in national health planning."
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Mr. Konneh says some or most of the oxytocin available to rural maternal waiting homes has expired. It is only used as a last resort. He also worries that women are avoiding the rooms. Despite the challenges Mr. Konneh urges pregnant women to use the rooms because they are still staffed by medical experts who will make a delivery safer.
"We agree that there is no food, no comfortable bed. We agree that in some places, no running water, but the facilities are there, and we have professional people. And we can start with that while we continue to engage the government to standardize our maternal waiting homes across the country."
Amelia Nyanamah's story had a happy end. She gave birth to a healthy baby boy. But in a worrying sign for Liberia's health officials, as she headed back to her village, Amelia said she would not come back to the clinic for her next birth. She will tell other women to avoid it too.
This story was a collaboration with New Narratives as part of the "Investigating Liberia" project. Funding was provided by the Swedish Embassy in Liberia. The funders had no say in the story's content.
