How Traditional Beliefs Contribute to Maternal Mortality in Rural Liberia


Rivercess County – In extreme labor which had been ongoing for two days, Martha Garway had to leave her village, Klaygbe to Pillar of Fire Mission in Yarni District via canoe on the Yarnie River – a journey that took her little over an hour.

Report by Mae Azango [email protected]

Being void of options, her husband could not leave his wife in that precarious situation.

He hired abled body men to carry her in a hammock to the river banks to commence her journey into Yarni where the only clinic in the district is located – on the premises of the Pillar of Fire Mission.

According to the husband Joseph Garway, Martha had been in labor two days earlier.

She was first taken to traditional midwife in the area. But the midwife, he said, could not help deliver the baby. Martha had some complications.

The midwife backed off the delivery, superstitiously accusing Martha of committing adultery for which she was suffering complications and having prolonged labor.

Resolving to take his wife to the clinic which is distance away across the river became the last resort for Joseph.

But canoes do not come by easily. He had to wait with his wife who was already in labor for the return of the canoe from across the river.

Alas, Martha did not end the journey alive. And so was the baby.

She is among hundreds of women in rural Liberia who sometimes die or narrowly survive delivery based on the mistaken beliefs of many untrained Traditional Midwives, (TTM) and Traditional Birth Attendants (TBA) who believe labor complications is the result of adultery.

The situation of Martha is just a small part of story in Liberia, where basic health care delivery services in many rural villages remain a challenge.

Women in these areas are forced to rely on untrained Traditional Midwives to do their deliveries, and the deplorable conditions of roads in rural Liberia compounds the challenge.

This is one of several reasons why maternal mortality had been high in Liberia.

In 2012, the United Nations Children’s Fund reported that Liberia had 990 maternal deaths per 100, 000 live births, 34 neonatal deaths per 1000 live births and a lifetime risk of maternal death of one in 20.

The corresponding values reported in 2014 were similar: 990 maternal deaths per 100, 000 live births, 27 neonatal deaths per 1000 live births and a lifetime risk of maternal death of one in 24. 

As the villagers witnessed the sad event of the Garway family unfolding before them their eyes, Sarah Jacobs, a lady who stood with tears in her eyes, began to explain her own similar and painful experience during the civil crisis in Liberia when she gave birth to her first son in Grand Bassa County.

“That midwife accused me of having an affair with a different man and not my husband, so I should confess my lover’s name; and as I bled, she beat my legs. 

Finally, I just pulled a name from the air and gave it to her,” said Sarah in a weeping voice.

She further explained that in an adjacent room, a man knocked some old cups together and said he was consulting the gods of their ancestors who would allow her to live because she had confessed the name of her ‘lover’.

“I had to lie to the midwife because I was bleeding too much and getting weak. 

After that, midwife gave me some of kerosene to drink, because she believed it would help bring down the afterbirth, and I passed out before I had the chance to hold my first child when the afterbirth came out,” Sarah explained.

 However, the maternal mortality situation in Liberia is beginning to improve as the government of Liberia over the years, has trained over 8,000 Trained Traditional Midwives (TTM), to improve their delivery skills.

In addition, they learn to offer basic prenatal care, to recognize early danger signs in pregnant women and transfer them to medical clinics before complicated labor begins.  TTMs are in integral part of the country’s strategy for reducing maternal deaths, which is supported by international donors. 

According to the Ministry of Health report, the proportion of deliveries attended by skilled personnel has increased from 46.3% in 2009 to 64.7% in 2010.

And over the past two years, Liberia has made significant progress towards improving maternal and child health by steadily reducing home-based delivery. Analyses of data on birth attended by skilled health worker indicate a decline of 26.3% from 1986 to 2010.

In addition, the Liberia demographic and health survey  in 2007 shows that almost 8 in 10 mothers (79%) receive prenatal care from a health professional (doctor, nurse, midwife or physician’s assistant), while 16% of mothers receive prenatal care from a traditional midwife and 4% of mothers do not receive any prenatal care.

Miatta Abraham, 43 years old, is a Trained Traditional Midwife who lives in Todee district in rural Montserrado.

She once confirmed in an interview, that a similar situation of Martha’s case happened in her District before their training.

“In some of the villages, there is no car road,” she said, “so people tote [carry the pregnant woman] in a hammock” to reach a clinic in time to deliver, but sometimes, they can die when the midwife who did not go under the training, waste time to bring them to the clinic soon,” she said.

However, the reduction in maternal deaths according the recent WHO maternal mortality survey puts Liberia at 770 maternal deaths to every 100,000 live birth.

This recent survey rates Liberia at the eighth place among countries with the highest maternal mortality rate in the world, with South Sudan, topping the chat with 2,054 maternal deaths.

South Sudden is followed by Chad who has 1,100 maternal deaths, Somalia 1,000 maternal deaths, Sierra Leone 890 maternal deaths, Central African Republic 890 maternal deaths, Burundi 800 maternal deaths and Guinea-Bissau 790, maternal deaths.

Even though Sarah survived, but other young women like Martha are not so lucky today, as the need for more trained Traditional Midwives to be deployed in difficult or hard to reach areas in many rural villages, remains a tough challenge.

And as the lack of roads and bridges remain an obstacle in preventing pregnant women of getting proper health care, the fight of maternal motility remains a huge challenge in time to come.