Liberia: More children surviving, more women dying in childbirth

MONROVIA, 21 April 2009 (IRIN) - The number of women dying in childbirth in Liberia has nearly doubled since the 1980s, according to a recent UN report that has policymakers calling for urgent attention to reproductive healthcare.

While the report shows encouraging trends in infant and child survival, it puts maternal mortality at 994 women per 100,000 live births in 2007 compared to 578 in 1987.

"We need to do something immediately and urgently about maternal mortality," said John Agbor, head of child survival for the UN Children's Fund.

The increasing proportion of women dying while giving birth is linked to a drop in the proportion of births attended by skilled health personnel, according to the UN report. In 2006 under half of births were attended by trained personnel versus 91 percent in 1986, according to the report on Liberia's progress on the Millennium Development Goals.

Even fewer deliveries ? 37 percent ? take place in health facilities, the report says.

Part of the problem is a lack of health personnel. Before civil war broke out in 1989, Liberia had 250 qualified licensed doctors, but now just 50 doctors serve 3.5 million people; many have gone overseas to work, according to government statistics.

As a result few women are referred to doctors for obstetric care, according to the same report. Jennie Fallah, who lives in the Monrovia suburb of Paynesville, told IRIN: "When I was about to deliver there was no doctor so I was forced to give birth [without] one?I really did not know what to do as I was in severe pain?there was a health centre near [my home] but there is no doctor or midwife there at night."

High adolescent pregnancy rates ? a third of all babies are born to teenagers ? and low literacy rates further compound maternal mortality, said UNICEF's Agbor.

George Gould, UNDP's National Policy Analyst in Liberia, told IRIN access to skilled health attendants has declined in rural areas partly because it is so difficult to attract health workers.

"There are no opportunities in the rural areas. There is no piped water or electricity or anything to attract personnel to work in these areas. Rural health workers need higher wages to pull them out of cities."

Child survival

Under-five mortality has been cut in half since 1992 to 111 per 1,000 live births, the report says, noting that Liberia is likely to meet the MDG goal to reduce by two thirds the under-five mortality rate by 2015. Infant mortality decreased from 139 per 100,000 live births in 1992 to 72 in 2007.

Infant mortality has dropped partly because vaccination rates vastly improved, according to Agbor. Five diseases ? pneumonia, diarrhoea, malaria, measles and AIDS ? account for half the deaths among children under five in Liberia, according to the report.

Immunisation rates for measles have risen significantly and Liberia has been polio-free for several years.

Since 1999 vitamin A supplements have also been widely distributed, significantly boosting hundreds of thousands of children's immunity to common killers such as diarrhoea and measles, UNICEF's Agbor said.

The UNDP's Gould said the government must remain vigilant in order to meet the infant mortality MDG. To build on progress already made, the Ministry of Health should continue supporting mass immunisations, providing vitamin supplements and insecticide-treated bed nets, alongside revitalising primary health care, he said.

"Reducing both maternal and infant mortality remain a priority," Agbor said. "If Liberia continues in this path the infant mortality MDG might be reached." But he added: "Reaching the maternal mortality MDG would clearly be an uphill task."

It is a task the government is finally taking on. When maternal death statistics came out in 2007 the Ministry of Health created a reproductive health policy, but it is only now being implemented.

"We have had a sustained period of peace and security," said Gould. "Health outreach activities can now be regular and planned, which should mean that progress against the MDGs now speeds up."

Progress will be documented in the country's next Demographic Health Survey, expected out in 2010.

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