-Experts speak



By Jerromie S. Walters

Access to quality healthcare is a fundamental human right, particularly for vulnerable populations such as pregnant women. Unfortunately, in Liberia, it appears to be taking a different trend, as a significant number of pregnant women are allegedly being denied access to medical attention and delivery services due to their inability to afford the required fees. This was reportedly displayed Saturday, December 16, 2023, when Ms. Lorpu Johnson, a young woman who needed urgent healthcare was allegedly denied by health workers at the Kakata Health Center in Margibi County, because she couldn’t meet up with the financial requirement.

According to Laydia Johnson, the sister of LorpuJohnson, she (her sister) was taken to the Kakata Health Center for delivery but was allegedly refused by authority of the health facility due to their inability to pay the amount of LD$21,000 for medical bills.“I brought my sister for her to give birth but we were asked by nurses to pay 21,000 (Twenty One Thousands Liberian Dollars) for treatment. My sister husband is dead and we don’t have money,” she said.

Ladia Johnson further noted- “Since we could not give them the money, we were asked out of the health facility. We slept outside the hospital gate appealing to them but they did not accept us.”

Meanwhile, it was reportedly observed that Lorpuexperienced severe bleeding as a result of the situation, while sitting outside of the facility without no other alternative. However, Lorpo Johnson later gave birth to a male child at the same facility (Kakata Health Center), Saturday evening, after some humanitarians and well-meaning Liberians intervened after they were alerted about the situation through social media (Facebook).

Earlier that day, individuals at the facility in MargibiCounty and other parts, confirmed that scores of women, including one of their wives- lost her life due to similar situation in the county. “They refused to accept my pregnant wife because we could not provide the money they asked for. My child die in the stomach of my wife since I did not give the money for the operation on time. I was told to give over 50 thousands for the operation. I am sad and want for the government to come to our aid,” George Binda, a resident of Kakata said.

Unfortunately, this alleged situation doesn’t seem to be unique to Margibi County alone, as Liberians at and in the environment of health facilities in other counties, especially Montserrado County, have acknowledged the agony of “No Money, No Service”. Margibi is next to Bong County, and according to media and medical practitioners in Bong, they say the situation of “No Money, No Service” is also common.

Margibi County Health Officer’s response

Margibi County Health Officer, Dr. Sianeh Jackson Mentoe, in a conversation with this paper via telephone, says the information is false and misleading. As earlier gathered, Dr. Sianeh Jackson Mentoe, said Lorpu gave birth at the facility and the actual story surrounding delivery is contrary what that was reported. Because of this, she disclosed that her office will host a major press conference today, Monday, December 18, 2023, in order to provide the needed clarity.

Experts’ Opinion

Experts say denying pregnant women access to medical attention during pregnancy and delivery greatly increases the risk of maternal morbidity and mortality. Without proper prenatal care, they say potential complications, such as gestational diabetes, hypertension, or infections, may go undetected, leading to serious health consequences for both the mother and the unborn child. They also stressed that in the absence of skilled birth attendants, the risk of birth-related complications, such as obstructed labor or postpartum hemorrhage, significantly increases, often resulting in maternal deaths.

Leroy Maximore, a health expert with a little over 19 years of experience in the medical profession, acknowledged that he has experienced instances of individuals being denied access to healthcare in Margibi, because they couldn’t meet up with the financial requirement (s). He frowned at act because he believes it’s enraged with several consequences, and as many know, the primary responsibility of health workers is to save lives.

However, Leroy Maximore who worked in Margibi County with the health team for several years, says actions of such are sometimes pushed by drastic administrative policies and mandates that require local staff to act as they are mandated. But regardless of the situation, he maintained that it is unjustifiable- weather at a private or public health facility.

Like Leroy Maximore, Comfort Saybah Zowulu, Liberia’s only female biomedical equipment technician and current member of the Lofa County health team, says the issue of “No Money, No Service” doesn’t play in the County. She tells WomenVoices that it is not right and it has not happened in the county, especially for where she works. This is because they recognize that as medical practitioners- it is expected of them to prioritize individuals’ lives.

At the government’s health facilities in Lofa, Ms. Comfort Saybah Zowulu says they don’t deny people if they are financially incapacitated. She confirms to this paper that they oftenallow initial commitment, which is expected to be followed by payment after the treatment or while it is ongoing.

In the case of Infant Health and Mortality, the various healthpractitioners who spoke with WomenVoices from medical facilities in Montserrado, Bong and Margibi counties, noted thatthe denial of medical attention to pregnant women also has severe consequences for infant health. Among several others, they highlighted that lack of prenatal care can lead to premature birth, low birth weight, and birth defects, all of which increase the likelihood of neonatal mortality. 

Additionally, the health experts say without skilled birth attendants, newborns are at a higher risk of birth asphyxia or infections, further contributing to infant mortality rates. This comes to play in the case of the famous slogan: “If the capable is not available, the available becomes the capable.” 

Referencing the case in Margibi County, the expert say the long-term consequences of denying access to medical attention during pregnancy and delivery can have a lasting impact on the health and well-being of the surviving infants. They say it extends beyond individual health outcomes.  With previous and the recent situation, the medical practitioners believe that the societal implications underscore the urgent need for accessible healthcare services for pregnant women in Liberia.

A 2022 USAID Family Planning and Reproductive Health report shows that 

Liberia has a maternal mortality ratio of 661 per 100,000 live births compared to 542 in sub-Saharan Africa, on average. Unfortunately, this concurs with the situation of Pregnant women at major government health facilities in Nimba County, who are said to be confronted with several challenges affecting safe delivery, thus fearing their lives and newborn babies.

The USAID 2022 report says the child mortality rate of Liberia  is 78 deaths among children under 5 per 1,000 live births, compared to 74 on average for the sub-Saharan region. But till the end of 2023, the issue of safe child birth remains complex for pregnant women in the West African nation.Women Voices Newspaper, in conversation with the pregnant women unearthed an increment in maternal death as the result of poor quality of health care, including  mistreatment, insufficient numbers of trained health workers, shortages of essential medical supplies, and poor accountability of health system.

Those major facilities include; the George Way Harley Hospital, Ganta United Methodist Hospital, Saclepea Comprehensive Health Center, and Bahn Health Center respectively.

Every year, pregnant women varied in age suffer life-altering injuries and died during childbirth on ground that hospitals and medical workers skip safety practices to handle the health disaster, Women Voices Newspaper investigation has found.

On Wednesday, 13 December, 2023, our Nimba County Correspondent embarked on a field visit to get firsthand account of challenges hindering women waiting safe delivery at those health facilities maternal room following pregnancy and childbirth. With 1,072 maternal deaths for every 100,000 births, Liberia has one of the highest maternal mortality rates in the world, according to UNICEF. The mortality rate of newborns, within the first 28 days of life, is also high – 37 for every 1,000 live births.

This paper latest survey also found that the number of maternal deaths of pregnant women reflects inequality, and access to quality health services, highlighting financial instability as major constrained for poor women in remote areas to receive adequate healthcare delivery services. The women who pleaded anonymity, expressed their greave concerns, linking maternal deaths to complications during pregnancy and childbirth, which most complications develop during pregnancy can be prevented or treated, but costly. 

Following the survey, WomenVoices established that major complications accounting for maternal deaths including severe bleeding after childbirth, infections usually after childbirth, high blood pressure during pregnancy, complications from delivery, and unsafe abortion respectively.