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Analytical summary - Gender and women's health

Da AHO

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The health care that a mother receives during pregnancy, at the time of delivery and soon after delivery is important for the survival and well-being of both the mother and her child. Maternal and childhood mortality are critical development and health indicators that determine a country’s progress towards the achievement of Millennium Development Goal 4 and Millennium Development Goal 5.

Young girls in the age group 10–18 years and single women are especially vulnerable and live uncertain lives. They have little access to and control of economic resources, have a poor sexual and reproductive health status, and their interests and opinions are rarely represented at the local level.

This fragile economic situation leads them to have multiple partners and engage in unwanted sex, because they have the responsibility of bringing up their children. Frequent sexual relations with multiple partners increases exposure to the GB virus (GBV) and results in frequent pregnancies. It also increases HIV and sexually transmitted infection transmission and negatively affects the self-esteem of women.

During Liberia’s 14-year long civil war, rape and other forms of sexual violence were used systematically to violate women and girls as acts of aggression and not necessarily simply as a means of satisfying sexual desires.

At the end of the civil war in 2003, around half of Liberia’s women had experienced GBV. The sexual assaults committed as war crimes did not only affect women; many men were forced to watch as mothers, sisters, wives and daughters were sexually abused, thereby losing power in the failure to live up to the established masculine identity model.[1]

Maternal mortality is high and has increased significantly in recent years, increasing from 578 deaths per 100 000 live births in 2000 to 994 deaths deaths per 100 000 live births in 2007.[2]

Mother and baby, Liberia

The main health factors contributing to the high level of maternal mortality include:

  • the acute shortage of skilled health workers
  • inadequate emergency obstetric care
  • inefficient and limited referral systems
  • poor nutritional status of pregnant women
  • high fertility rates and extremely high number of teenage pregnancies
  • low access to family planning services.

Moreover, less than half of births are attended by skilled and trained health professionals.[2]

Direct causes of maternal death accounted for 52% of institutional maternal deaths in Liberia, 42% were due to indirect causes while 6% were women who died during pregnancy did not have sufficient information to record them as either direct or indirect causes in facility registers (see figure).[2]

Causes of maternal deaths [2]

The main causes of institutional maternal mortality were haemorrhage (17%), retained placenta (15%), eclampsia (13%) and complications of abortions (13%), while 18% of direct maternal causes were classified as other maternal deaths.[2]

The most common indirect maternal mortality diagnoses were malaria (24%) and anaemia (19%). However, more than half (53%) of indirect institutional deaths were classified as “other” without specification.[2]

According to the Liberia demographic and health survey 2007, 87% of all women had heard of a method of contraception, compared with 92% of all men. The results also indicated that only about one in nine currently married women (11%) were currently using some method of contraception.[2]

Modern methods of contraception accounted for almost all the use, with 10% of married women reporting using a modern method versus only 1% using a traditional method. Injections and pills were the most widely used methods (each used by 4% of married women), followed by condoms (2%).[2]

In 2007, a HIV sentinel seroprevalence survey was conducted for a period of 6–10 weeks at 15 sentinel sites located in 12 counties, in the five health regions. The survey showed HIV prevalence among 15–24 year olds was 5.3%. The highest prevalence of 6.4% was observed in women aged 30–34 years, while the lowest prevalence of 4.6% was observed in women aged 35–39 years.[3]

References

  1. Munala J. Challenging Liberian attitudes towards violence against women. Forced Migration Review, 2007, 27
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Liberia demographic and health survey 2007 (pdf 2.5Mb). Monrovia, Liberia Institute of Statistics and Geo-Information Services, Ministry of Health and Social Welfare National AIDS Control Program and Macro International, 2008
  3. Antenatal care survey 2007. Monrovia, Government of Liberia, Ministry of health and Social Welfare, 2007