Reducing Maternal Mortality in Liberia by Increasing the Information Dissemination for Maternal Education


Academic Paper, 2017

11 Pages, Grade: 5.0


Excerpt

Table of Contents

Introduction

An Overview of Maternal Mortality

A Review of Liberia’s very high Maternal Mortality

A case for improving information dissemination for combating maternal mortality
1. The high illiteracy rate in Liberia and its contribution to high maternal mortality
2. The underutilization of relatively improved and expanded maternal health facilities and services

Discussion

Findings, conclusion and recommendations

Bibliography

Abstract

This paper argues that the lack of a continuous, serious and robust government-driven and coordinated information dissemination program in Liberia on the importance of antenatal care among a highly illiterate population constitutes significant impediment to the overall goal to reducing maternal mortality and contributes to the high rate of maternal mortality. The argument is founded on two fundamental observations. These observations include: the high illiteracy rate in Liberia and its contribution to maternal mortality and, the underutilization improved and expanded maternal health facilities and services. We see these two points as mutually reinforcing and that one will not fare well in the absence of the other. We conclude with five precursory recommendations and emphasize that if any policy to reduce maternal mortality in Liberia is to be successful, holding all other factors constant, such policy must include a deliberate program for increasing information dissemination for maternal education.

Keywords: Maternal mortality, information dissemination, antenatal care, illiteracy, Liberia healthcare

Introduction

This topic is significant for some fundamental reasons. First, it reviews the current high maternal mortality trend in Liberia and its causes as well as where the health sector places emphasis in its efforts to reverse the troubling trend. Second, given that the government of Liberia does not have any continuous, serious and robust information dissemination program, as we could not find such in the policy documents reviewed, this paper argues that not much consideration is being given to the potential that increasing information dissemination has for enhancing maternal education and thereby contributing to a decrease in the current high maternal mortality rate in Liberia. The paper posits that illiteracy is a major factor in the high maternal mortality rate in Liberia. In support of this postulate we look at relevant data on literacy from Liberia and found high levels of illiteracy especially among women. Third, the paper looks at the level of improvements in the health sector of the country particularly; regarding maternal care and argues that, though it still leaves much to be desired, if pregnant women are regularly provided with the necessary information regarding the importance of maternal care, doctor’s visit, where to seek maternal care and how often to do so, this will promote the education and change of attitude the combination of which will influence them to utilize existing maternal health services more and to take other proactive health measures.

This paper argues that given the high illiteracy rate in Liberia notwithstanding the improvements in health delivery care, the reasons behind the high increase in maternal mortality may not be fully accounted for only by low emergency obstetrics, high home deliveries by unskilled personnel and shortage of midwives. That level of education, it has been shown, has significant function in whether a country does well in its maternal mortality ratings or not.

Therefore this paper attempts to make a case that while efforts are being made to further improve emergency obstetrics; reduce home deliveries by unskilled personnel and shortage of midwives, among others, all of which are indispensable to a properly functioning maternal health system, the lack of information dissemination on the importance of antenatal care among a highly illiterate population constitutes significant impediment to the overall goal of reducing maternal mortality and contributes to the high rate of maternal mortality.

An Overview of Maternal Mortality

Maternal mortality is defined as the death of a pregnant woman during pregnancy, or within 42 days of termination of pregnancy, regardless of the duration and the site of the pregnancy, as long as the death is due to cause (s) connected to or exacerbated by the pregnancy or its management. This includes direct or indirect obstetric death and excludes accidental or incidental causes.[1] Every day, approximately 830 women die from preventable causes related to pregnancy and childbirth, 99% of all such deaths happen in developing countries.[2] Maternal mortality is higher in women living in rural areas and among poorer communities. Young adolescents face a higher risk of complications and death as a result of pregnancy than other women.[3] While it still high as it is currently, it is important to note that between 1990 to 2015 maternal mortality worldwide dropped by about 44%. The Sustainable Development Goals successor program to the Millennium Development Goals seeks to reduce maternal mortality to 70 deaths per 100, 000 live births globally between 2016 and 2030.[4] Women in developing countries on average, have many more pregnancies than women in developed countries. This situation makes their lifetime risk of death due to pregnancy higher. The probability that a 15-year old woman will eventually perish due to maternal causes is 1 in every 4,900 persons in developed. In countries designated as fragile states, the risk is 1 in 54; showing the consequences from breakdowns in health systems.[5]

The phenomenon of maternal mortality remains very high in sub-Saharan Africa though progress against it is being achieved in all regions of the world. The good news is that, since most maternal deaths result from preventable causes, almost all maternal deaths can be prevented. There is no gainsaying that poverty contributes to maternal mortality. According to the UNICEF, this is evidenced by the huge disparities found between the richest and poorest countries. Additionally, the risk of maternal death in high-income countries is 1 in 3,300 contrasted with 1 in 41 in low-income countries.[6]

A Review of Liberia’s very high Maternal Mortality

Liberia currently has one of the highest burdens of maternal mortality in the world.[7] The Ministry of Health of Liberia attributes this to low emergency obstetrics, high home deliveries by unskilled personnel and shortage of midwives.[8] The trend has been steadily deteriorating from 578 per 100, 000 live births in 2005[9] to 990 per 100,000 live births in 2011.[10] Currently maternal mortality in Liberia is approximated to stand at around 1,072 per 100,000 live births as of 2015.[11] This makes Liberia one of the countries with the highest maternal mortality rates in the world.[12] According to the UNICEF Liberia 2012-2017 country programme document, the trend has worsened in spite of improvement in antenatal care.[13]

What is most troubling is that the entire increasing trend in maternal mortality is happening amidst significant improvements in the Liberian health sector. The World Health Organization in its Country Cooperation Strategy of 2017 reports an increase by 27% in the functional health facilities of the country between 2010 and 2016. The same report also indicates important upturns in key interventions areas including antenatal coverage and immunization. The report also mentions a decline from 41% in 2008 to 29% in 2015 of the population that has to travel more than 1 hour to access health facility. Additionally, the reports shows that the per capita expenditure on healthy has increased from less than US$20 to 21% in 2000 to US$46 in 2014 and that out-of-pocket expenditure accounted for 21% of total health expenditure.[14]

In its September 2015 report to the UN Secretary-General, Mr. Bin Ki-Moon, the Government of Liberia reaffirmed its commitment to the Global Strategy for Women’s and Children’ Health launched in 2010, and outlined some gains as well as challenges including the Ebola onslaught in 2014 to achieving some key milestones. However, the government did not make any specific mention of the need or importance of information dissemination as an element of its sustainable action to end maternal mortality.

Unfortunately, through all of the policy documents and reports we accessed for this paper, there was not seen any nationwide, aggressive government-coordinated information dissemination program to educate women and men on the danger of maternal mortality and what actions to take to prevent it.

A case for improving information dissemination for combating maternal mortality

While the relatively weak presence and poor quality of healthcare may seem the putative reason for this for high maternal mortality in Liberia, these alone may not give a fuller understanding of the phenomenon. The thinking that availability, accessibility, and affordability of healthcare facilities are the sole factors for determining maternal health care or health in general is problematized by the fact that human behavior and choices play important roles in decision making.[15] We believe that the lack of proper information to pregnant women on how and where to seek prenatal care, and to encourage them to do so is a key factor that may explain the high maternal mortality level in Liberia.

Data from Demographic Health Surveys in Liberia indicate low utilization of basic healthcare particularly in rural areas where only 25.5 percent of women delivered by health professionals.[16] These factors combined, controlling for others, including shortage of midwives and other economic problems, are important for reinforcing the perspective that the high maternal mortality burden of Liberia may be due to the fact that pregnant women are not fully utilizing the available health services because of the lack of information which could influence their behavior to increase doctor’s visit and utilize existing services more.

Interestingly, in all the policy documents reviewed including the SDG Goal-3 on Strategy for Women’s, Children and Adolescents’ Health, the Indicator and Monitoring Framework for the Global Strategy on the Strategy for Women’s, Children and Adolescents’ Health (2016-2030) of the Health Ministry of Liberia of Liberia, Investment Case for Reproductive, Maternal New Born, Child, and Adolescent Health 2016-2020, Liberia Demographic Health Survey (LDHS 2013, UNICEF Liberia country programme document 2012-2017, no case was made for aggressive government-driven information dissemination on maternal mortality. Even though much emphasis is placed on strengthening health systems, ensuring universal health coverage for comprehensive reproductive, maternal, and newborn care, among others, no particular attention is given to the importance of information dissemination as a tool for providing maternal education to pregnant women and which will influence them to access existing services more and as a way of preventing mortality and decreasing overall death rates.

[...]


[1] International Classification of Diseases (ICD), International Classification of Diseases, Volume-2 Instruction Manual.10th Revision, Geneva, World Health Organization, 2010). ((Accessed July 12, 2017).)

[2] World Health Organization, Maternal Mortality, Fact Sheet 2016 (Accessed July 14, 2017)

[3] Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: Cross-sectional study. Conde-Agudelo A, Belizan JM, Lammers C. American Journal of Obstetrics and Gynecology,2004, 192:342–349

[4] SDG Goal-3

[5] World Health Organization, Maternal Mortality, Fact Sheet 2016 (Accessed July 14, 2017)

[6] UNICEF Data: Monitoring the Situation of Children and Women

[7] 8Ministry of Liberia of Liberia, Investment Case for Reproductive, Maternal New Born, Child, and Adolescent Health 2016-2020

[8] Ibid.

[9] Liberia Demographic Health Survey (LDHS 2000).

[10] Human Development Report (2011).

[11] Liberia Demographic Health Survey (LDHS 2013).

[12] World Bank.Maternal mortality ratio (modeled estimate, per 100 000 live births).((Accessed July 12, 2017).)http://data.worldbank.org/indicator/SH.STA.MMRT?locations=LR

[13] UNICEF Liberia country programme document 2012-2017 ((Accessed July, 12 2017).)

[14] Country Cooperation Strategy of 2017

[15] Phillips KA, Morrison KR, Andersen R, Aday LA, Health Serv Res. 1998 Aug; 33(3 Pt 1):571-96. (Accessed July, 122017).)

[16] Kruk ME, Rockers PC, Varpilah ST, Macauley R. Which doctor?: Determinants of utilization of formal and informal health care in post-conflict Liberia. Med Care. 2011;49(6):585–591. doi: 10.1097/MLR.0b013e31820f0dd4.[PubMedCrossRef(Accessed July 12, 2017).)

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Details

Title
Reducing Maternal Mortality in Liberia by Increasing the Information Dissemination for Maternal Education
College
Sophia University Yotsuya Campus  (Graduate School of Global Studies)
Course
Global Studies
Grade
5.0
Author
Year
2017
Pages
11
Catalog Number
V382797
ISBN (eBook)
9783668581937
ISBN (Book)
9783668581944
File size
455 KB
Language
English
Notes
Tags
reducing, maternal, mortality, liberia, increasing, information, dissemination, education
Quote paper
Baba Sillah (Author), 2017, Reducing Maternal Mortality in Liberia by Increasing the Information Dissemination for Maternal Education, Munich, GRIN Verlag, https://www.grin.com/document/382797

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