Monrovia – Princess Millimouno was just a high school graduate when she got pregnant with her first child.

Report by Tecee Boley

Then a teenager, she was chastised by her father and the well-meaning community members. For young Princess everything seemed lost. 

She dropped out of school.  Her dream of going to the university became a faint hallucination. 

Her wonderful ambition of becoming a medical practitioner in Liberia, where professionals are much needed, was blurred.  

“When I got pregnant I was unhappy about my pregnancy. Because of this, I use to be so sad and so confused.

I even lost hope. I felt very, very disappointed in myself.  I had planned that after high school I would further my education at the university level. I was so unhappy that I stopped walking around the community.”

Princess is just one of thousands of young girls in Liberia who have to feel the pinch of an unwanted pregnancy.

Most young girls never go back to school or have the opportunity to hold a book least to say read or write.

As unfortunate as the situation seems Princess is lucky, she came in contact with the Big Belly Business Book- the first pregnancy guide written in simple Liberian English.

“One evening I was sitting on my porch with my head bent down. As soon as I lifted my head I saw two people walking towards me- a man and a woman.

They talked to me about the Big Belly Business program.

I turn my head on the other side and asked how they knew I was pregnant because I was doing my best to hide it.

Later I followed them to the town hall meeting. They introduced the book to us.”

The book soon became a source of strength and hope for Princess. She had something to read other than her notes from school.

Gradually, she was learning new things. Some of those things shocked her while some of them were entertaining, taking her mind off her worries.

Princess could no longer keep all the insightful and powerful information to herself.

She volunteered to work with the Traditional Women United for Peace in her community as a trained Big Belly Sister.

As a Big Belly Sister she uses the beautiful illustrations in the book to teach women who are uneducated how to use the pregnancy guide.

“I go about talking to pregnant women, teaching them to know about themselves. Telling them about things they are propose to do and what they are not to do. I also strive to change people’s minds about pregnancy myths.

Some people still believe that a pregnant woman should not eat pineapple because it will put sores on the baby’s body. I have been able to convince some people that this is not true.”

This may be a small step but it is a live saving knowledge in a country with one of the highest maternal mortality rates in the world.

The country’s entire health system collapsed during one of the world’s most deadly outbreaks of the Ebola virus. 

Causing the maternal mortality rate to climb up to 994 deaths per 100 000 live births.  Part of the reason is lack of the right information.

That is why the information sharing section is the key segment of every club meeting that Princess facilitates.

Today she facilitates one of the biggest clubs run by her organization.

The white sand in the yard of the Town Hall glitters from reflection of the bright sunlight of the afternoon. 

The Town Hall- an unpainted big block building stands tall amongst new zinc shakes in New West Point Community.

But it is not the glittering sand or dissimilar look of this building that sets it apart from others in this shanty town.

The sound of a group of women reading together and discussing a book is strange.  Most women in communities like these do not read. The statistics is staggering.

Women represent less than 40 percent of educated people in Liberia, according to last Liberia Demographic and Health Survey. This is why any book that makes a woman interested is so important to all of Liberia.

The Big Belly Business book is motivating women in this community to read, discuss and share their experiences with one another.  “Is….Something …

Smelling….. ?” They read aloud page 64 of the book.  About 35 of them are seated here.  A woman lifts her hand. Yes says Princess at the same time pointing at a young woman.

Amie Kallon is a new mother. She tells the group how she hated the smell of a certain food during her pregnancy.

She also has been doing more to assist Princess. She carries the books and help to distribute them.

“I have learnt a whole lot from these meetings. I feel that Princess is doing well. I admire the way she talks to us. 

I forgot about some words because it has been long since I went to school. Now I am able to spell them.

Princess did not go back to get pregnant she is taking family planning. She is even going to school to be a nurse. I want to be like her someday. Now I am in training to be a Big Belly Sister just like her,” says Kallon.

 Kallon did not take birth control after her other two children. However she is not the only person who has decided to change her way of life.  

The entire community of Kpalla, concluding their chair person, Augustine K. Denuwollie has decided to encourage every pregnant woman to attend clinic.

“Since we started the Big Belly Club meetings at the clinic, they told us that nobody should treat pregnant women at home.

All tablets, all checking and all treatment should be done at the clinic here. And that is what happening now. I thank God the community is safe.

If a person refuses to come to the clinic when I catch that person I will fine that person along with anyone who administers the treatment at home.

First offense is LD$750.00 (about US$8.00). Second offense is LD$1500.00 (US$15.00). The person will be expelled from the community on the third offense.”

While Denuwolllie is taking serious measures to ensure women’s health in his community, the Afro-Medical Health and Welfare Services in 72^nd Community is putting up a good fight against teenage pregnancy.

“Teenage pregnancy has been a national problem for a long time now in Liberia.

Most of the girls who get pregnant, when they learn from the groups that family planning will help them to do spacing, will help them to achieve some of their educational and professional goals, they take that seriously.

Girls who come to our meetings are often different from those who do not come.

Those who do not get in contact with the program will have two or three children in no time,” says Executive Director Patience B. Flomo.

The change is not only for young girls. Dr. Joseph L. Kerkula, Director of the Family Health Division says even in the delivery room changes are occurring. Some men in Liberia are now present at the delivery of their babies.

“It depends; I am saying this to say normally we say that the man and the lady decide that the lady gets sick for nine months.

Since the man identifies himself with the woman and will want to share in that responsibility in giving her all of the psychological support in having a smooth delivery. In some instances-Yes, Permission is granted.”

Back to New West Point, Princess’ experience of the delivery room is completely different.

The father of her child was not present neither was any other family member allowed in the delivery room.

However she vows that her next baby will only come when she is fully capable of caring for it. Princess says page 219 of the Big Belly Business Book should be the business of every young girl as it helps to secure a better future.

Monrovia – Gender, Children and Social Protection Minister Julia Duncan-Cassell has echoed that big belly business must not be overlooked in Liberia since it has the ability to cause harm to the population of women and girls across Liberia.

Report by Willie N. Tokpah – willie.tokpah@frontpageafricaonline.com

Speaking over the weekend at the launch of the big belly business book in Monrovia, Minister Cassell said, there is urgent need that government and citizens work in addressing problem faced by big belly people.

“Looking back at your work with the Ministry and agencies of government since 2013, we can say a lot has been done” said Minister Cassell.

She lauded the US Government for increase support towards the program aimed at targeting approximately 50 thousand families by 2017.

The Minister recognized effort of collaboration by NGO’s, naming it as an important tool to improving health delivery system that is already undergoing a reform. Minister Cassel further noted that the process will help government build a resilient health system in line with the Ministry of Health.

“We hope that this can start early before the gender base big belly program” the Minister cited.

She wants the Ministry of Education to integrate the big belly business program into some of its work plan.

“As I launch this program today, let me remind all of us here that a high percentage of women do not know the good and bad as well as safety issues associated with pregnancies including options” Minister Cassell added.

The Gender, Social and Child Protection Minister challenged parents to participate in all medical care as a means of making informed choices about deliveries.

Cassell complained that women and girls hardly make informed choices in most medical situations relative to treatments and cares.

According to her, access to information is important to pregnant women and the bug belly program serves as a guide.

Moreover, the Gender, Social and Social Protection Minister wants the big belly program to be seen as a provision of professional sources of information, building the skills of women and girls during their pregnancies and deliveries period.

She then emphasized the need for the program to impact parents and creates the right outcome for pregnant women for a successful and affordable healthcare program.

“It should support a maternal care system that does not discriminate and recognizes that girls can safely give birth in hospitals, birth centers and homes”, said Minister Cassell.

Moreover, Cassell said, the program should be used as an advocacy tool to assist women and girls and also support them to live up with pregnancies since big belly business is everybody’s business.

Minister Cassell is meanwhile calling on citizens in the country to work in encouraging women and girls about the important of education, despite pregnancies.

For his part, the Director of Family Health Division at the Ministry of Health Dr. Joseph Kerkula has described the program as an innovation to prepare babies who are going through the nine-month stage and as well creating a way in helping to reduce maternal death across Liberia, thus improving the health of children and mothers in various communities.

“The book can help you explain this story to another pregnant mother, be it educated or not, in taking the necessary precaution to make sure the mother and baby are safe” Dr. Kerkula opined.

Dr. Kerkula reminded that the participant that programs are often not documented, saying it is bad for Liberia.

He then expressed the need for pregnant women and mothers at various health centres to have access to the big belly business book since none of them should die while giving birth.

Monrovia – The official launch of the Big Belly Business program will celebrate the first pregnancy guide written in simple Liberian English, which is being distributed to 50,000 big belly women throughout the country.

The Big Belly Business book and the clubs formed around it which bring big belly women together in small groups, offer a new way of thinking about pregnancy as a learning opportunity that will help both children and parents. 

An informed, confident parent can be her own, and her child’s best advocate for school, for health, for life.

The program builds the capacity of front-line health workers to provide accurate health information and empowering literacy education for expecting and new parents.

The book is filled with engaging stories written by members of the Liberian Association of Writers, along with evidence-based health information and wisdom collected from conversations with many Liberian men and women all over the country and from an advisory board of experts and leaders in health, education, gender and religion.

The book explains what will happen at ANC visits, ways to deal with the normal symptoms of big belly, how men and other family can support big belly women, how to have a healthy belly and what to expect at the midwife visit. 

Funny and touching stories that talk about the chichipoley of family and belly in villages across the country keep readers engaged.

Renowned Liberian artist Chase Walker has made the book come alive by creating characters that accompany people throughout the book, many of whom “speak” about their big belly experience.  An audio version of the book, with music, can be heard on the radio or downloaded and listened to on a phone. 

The Open Society Initiative for West Africa (OSIWA) is leading the pilot Big Belly Business program and 13 partner NGOs across the country are running it. In the last year, these organizations have brought together pregnant women, men and elders at over 100 Big Belly Clubs each week. The Big Belly clubs use the Big Belly Business book to find and discuss health information and stories.

A special group “framework” was developed to ensure everyone has a chance to share, write or draw their own story – and ask, and discuss their own questions about pregnancy – together deciding what they want for themselves, their families and their community.

Over 100 Liberians from NGOs across the country have been trained as Big Belly Sisters and Brothers. They include midwives, or Traditional Birth Attendants, educators, clinic staff and soon, some of the “graduates” of the Big Belly Club will become Big Belly Sisters because they have learned so much! Big Belly Sisters invite everyone to the club to talk, learn, laugh, and plan together for healthier pregnancies and safer deliveries.

Evaluation of the program is ongoing. Interviews with participants indicate people are learning and incorporating healthy behaviors.

Leyla Cooper lives in Bong County. Of her seven pregnancies, unfortunately only two children survive. 

After attending the clubs, she says she has learned so much, including why and how to save money for delivery costs.

“I do not want this program to stop,” she says, “because the different thing is educating us to know we should take care of ourselves, how we should take care of our babies, and how our husbands should take care of us. 

Some of us cannot read but they (Big Belly Sisters and Midwives) can. My husband reads the Big Belly book to me. Things cannot change in one day but small, small they are changing. So I thank you.”

Midwife Gracious Meapeh from the maternal waiting home run by Africare in Handii agrees.

“It was hard for us to get the pregnant women to come to the Maternal Waiting Home.  We used to get about three to four persons –  but now because of the Big Belly Club we get fifteen to eighteen a month – Since then we have not had any maternal deaths, “ she adds.

The Big Belly Business program began in June 2012 when former U.S. Secretary of State Hillary Clinton announced the launch of the Women’s Health Innovation Program (WHIP), a small grants program that would support women’s learning and build the capacity of women focused NGOs in the country.

The program is a partnership of the U.S. State Department’s Office of Global Women’s Issues and over 16 NGOs and government agencies in the US and Liberia, as well as 16 NGOs in Bangladesh who are part of the complementary Babu Barta (Baby News) program. 

The WHIP partner grantees received Big Belly Books and materials, staff training, funding to run clubs and technical assistance for grant writing and reporting. The Big Belly Business team is based at OSIWA.

Partner agencies include: Alfalit, Africare, AfroMed, Hope For Women International, New Narratives, National Adult Education Association of Liberia (NEAL), Rescue Our People, Life Line Liberia, Lutheran Church of Liberia, Obaa’s Girls, Simply Put Media, Sirleaf Market Women’s Fund, THINK, Todhe Resource Center, Traditional Women United For Peace, United Church of the World, War Affected Women’s Educational Empowerment Program (WAWEEP),The What To Expect Foundation.

The second phase of the pilot will open the program materials and training to other NGOs interested in joining. 

Save the Children has already become a new partner.  The Big Belly team hopes to work with midwifery schools, hospitals and community health workers so they can best use the Big Belly book and framework during ANC and home visits to deliver respectful maternal care and education.