Image of Maternal mortality and the metempsychosis of user fees in Liberia: A mixed-methods analysis

Reproductive Health and Wellness

Maternal mortality and the metempsychosis of user fees in Liberia: A mixed-methods analysis

Download PDF

Liberia, a country recently afflicted by civil conflict and an epidemic of Ebola virus disease, has one of the highest rates of maternal mortality in the world. A biosocial analysis of this problem can help identify and address barriers impeding access to, and equitable de- livery of, quality maternal health care. We analyzed 258 maternal death reviews reported to the National Public Health Institute of Liberia in 2017 and compared data with existing demographic and health statistics. Quantitative information on maternal death was contextualized with 44 in-depth interviews conducted among four groups of study participants. Forty percent of reported maternal deaths in 2017 occurred among women 25–34 years old; 36% were due to hemorrhage; 74% occurred at a health facility, and 29% occurred within 24 h after delivery. The number of deaths reported to the government of Liberia through maternal death reviews ( n = 258) was substantially lower than the number expected based on the size of the population, crude birth rate, and the maternal mortality ratio. Qualitative findings highlighted inaccessible and unreliable transportation to health facilities; staff-related challenges, including staff attrition and burnout, inadequate training and clinical proficiency, staff absences, and neglect of patients; a lack of drugs and medical supplies; and the emergence of an inefficient and financially burdensome system of referrals by trained traditional midwives. Most notable was the finding that user fees for maternal health care in Liberia—eliminated in public facilities after the war—have resurfaced in the form of informal, out-of-pocket expenditures made by patients and their families.

Detail Information
Publication Information
: ELSEVIER B.V..,
Number of Pages
-
ISBN
-
Language
English
ISSN
-
Subject(s)
Maternal mortality User fees Liberia Structural de
Description
-
Citation
Other Information
Type
Article
Part Of Series
-
DOI Identifier
-
Related Publications

No Related Publications available

Comments