Monrovia/Freetown/Kenema — Maternal and infant deaths in Liberia and Sierra Leone are set to rise above their current alarming rates as fear of Ebola keeps pregnant women away from hospitals and makes already-scarce health workers reluctant to deliver babies.
"At the beginning of the outbreak, health service staff were the ones getting Ebola - many of them were dying. And they had no facilities to help sufferers. People grew terrified and when news spread, everyone got scared," said the head of maternal health for the UN Children's Fund (UNICEF) in Sierra Leone, Augustin Kabano. "Some centres have just two or three staff so if one dies, the whole system shuts down."
Liberia and Sierra Leone already have some of the world's worst maternal and infant death rates though they are better than they were: In 2010 some 890 women in Sierra Leone died per 100,000 live births, down from 2,000 ten years earlier. In Liberia 770 per 100,000 died in 2010, down from 1,100 in 2005, according to UNICEF. The improvements are linked to the introduction of free health care to pregnant, birthing and lactating women in public health facilities. Both countries had also upped the number of births attended by a health professional to 63 percent in Sierra Leone in 2012, and 46 percent in Liberia.
But when Ebola broke out in Sierra Leone in May, and Liberia in August, the number of births attended by a health professional in Liberia dropped from 52 percent to 38 percent, while the number of women in Sierra Leone attending hospitals and health centres to give birth has dropped by 30 percent, according to the countries' respective Health Management Information Systems. These attendance rates will increase maternal and infant death rates, said Kabano, though the extent of this will probably only become clear once studies take place (such as the government-UNICEF comprehensive health indicator study to be rolled out in Sierra Leone in 2015).
Fear on the part of health workers, combined with a shortage of midwives or doctors available to deliver babies, led to the death of expectant Fatumatta Fofana, a mother of five from Bushrod Island, a slum neighbourhood in Monrovia, according to her brother Mohammed Sheriff.
Fofana was turned away from her local clinic because there was no nurse or doctor available. She tried Redemption and JFK hospitals, but they, too, were closed because the government had temporarily shut down all state hospitals amid mass health worker deaths. Fofana finally turned to a small clinic called Muslim Clinic, but its administrator Alieu Konneh said he could not find a doctor who would come to help her deliver. Fofana died a few hours later and her baby did not survive.
Sheriff blames the government: "My sister get four children. I believe when the clinic was open, she could give birth easily but because government closed all the clinics, so she could not make it. I blame the government the way she died."
JFK hospital has since reopened its maternity ward but only for patients receiving pre-natal care, as staff are too afraid to treat women in labour who may be Ebola-positive, said a doctor who preferred anonymity.
High doctors' fees
Doctors are also charging extortionate fees to women to give birth - not a new practice, but the fee has gone up, said a doctor who asked to remain unnamed, linked to the associated risk of a potential Ebola-positive birth.
When Comfort Fayiah, from Monrovia's Paynesville neighbourhood, went to Benson hospital, which is run by the Ministry of Health in Monrovia to give birth, doctors there demanded US$400 to deliver her baby but she did not have the money and was forced to give birth on the floor of a makeshift church a few yards from the hospital, with no one but the church's pastor, Mother Reeves, to help her. She birthed twin girls and called them Mercy and Faith.
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