Maternal Waiting Homes in Liberia Fail Expectant Mothers Amid Dire Resource Shortages

In the heart of rural Liberia, the plight of expectant mothers is becoming increasingly dire as maternal waiting homes are found to be lacking essential resources. For women like Amelia Nyanamah, who trekked ten kilometers to the Lugbeyee Clinic expecting a safe haven for her impending delivery, the reality is starkly different. Upon her arrival, what awaited her was not the support she anticipated, but a facility devoid of basic necessities—no food, no soap, no clean linens, and critically, no common medications needed during labor. Amelia’s experience is not an isolated incident. The maternal waiting homes, established with the hope of reducing Liberia's alarmingly high maternal and infant mortality rates, are now under threat. Between 2010 and 2018, the Liberian government, supported by international partnerships, constructed 119 maternal waiting homes throughout the country, including 19 in Nimba County alone. The aim was clear: to enhance sexual and reproductive healthcare access in an effort to combat the troubling statistics that saw four women dying every day in childbirth, a figure that has only marginally improved to three daily in recent years. However, the conditions reported by mothers and midwives reveal a grim reality. Concerns are emerging that many women are now opting to give birth at home rather than risk the journey to these facilities, fearing that the absence of necessary medical supplies and supportive care could lead to dire consequences. Birth injuries, including life-altering conditions such as fistulas, are becoming more prevalent as health professionals warn of the risks involved in unassisted labor. At the Zorgowee Maternal Waiting Home, Edwina Ben, another mother nearing her delivery date, echoed Amelia’s frustrations. Despite her midwife's advice to remain in the facility for safety, Edwina felt compelled to leave due to the absence of essential food and care provisions. “The things them that supposed to be here to make me feel good is not here,” she lamented, emphasizing the role of her husband as the primary provider of food during this critical time. Midwives on the ground, like Marion Y. Dahn at the Lugbeyee facility, are sounding alarms about the precarious conditions they face. The limited availability of vital medications, such as oxytocin and hydration fluids, has pushed some midwives to take matters into their own hands, even purchasing medications out of pocket to ensure that mothers receive the care they require. The challenges have not gone unnoticed by local health officials. Karntay Deemie, health services director for the Nimba County Health Team, acknowledged the serious deficiencies affecting maternal waiting homes and attributed the problem to the sheer volume of women utilizing these facilities. He suggested that the burden should not solely lie with the government but with families to provide necessary support for expectant mothers. Critics, including Ayouba Mohammed Konneh of the Liberia Midwives Association, counter that the issues reflected in Nimba are widespread and underscore a national crisis. He points to systemic underfunding and the exclusion of maternal waiting homes from Liberia’s National Health Plan as significant barriers preventing progress. The lack of basic infrastructure and resources has made these homes unsafe, discouraging women from seeking the assistance they need. Encouragingly, even amid these challenges, Konneh urges pregnant women to utilize the waiting homes, reiterating that trained professionals are present to aid in deliveries. While the facilities are devoid of comfort and basic amenities, the expertise of midwives remains a vital lifeline for mothers in need. Amelia's story may have concluded positively with the birth of her healthy baby boy, but her decision to avoid the waiting home for future pregnancies poses a concerning trend for Liberia’s healthcare system. As she returns to her village, Amelia's intent to dissuade other women from utilizing the maternal waiting home reflects a broader issue that health officials must urgently address. Without a concerted effort to improve conditions and ensure adequate resources are available, the dreams of safe pregnancies and healthy deliveries for many mothers and their babies in Liberia may remain just that—dreams.