18 July 2008
The survey was initiated in early 2007, when UNFPA collaborated with the government of Liberia, the US Centres for Disease Control and Prevention (CDC), John Snow, Inc. and USAID to assess post-war reproductive health and recommend improvements. One result was the Women’s Reproductive Health in Liberia; the Lofa County Reproductive Health Survey.
However, even with the support from the communities, the team faced many obstacles while attempting to collect the data during January and February. Specific communities were identified to make sure that the data were statistically sound, but many of the vicinities proved too difficult to reach; the CDC had to recalculate sample frames in order to ensure data reliability.
Photo to the right: Driving on rugged roads into Lofa County. Photo: UNFPA
The results of the survey were shocking: 96 per cent had lost shelter due to the war, 90.8 per cent had lost their livelihoods, and 72.8 per cent had lost a family member. More than half of all women in Lofa County were victims of at least one incident of sexual violence during the 1999-2003 conflict.
The women fared slightly better in terms of getting obstetric care, mainly because some were able to obtain services from health facilities and doctors in neighbouring countries. But the survey showed huge gaps in care: more than 75 per cent women of women who had recently given birth had experienced complications during pregnancy, and approximately one fifth of them did not seek medical help. Almost half of all recent births (47.5 per cent) occurred at home, without the assistance of a skilled medical attendant. Other reproductive health indicators showed lack of contraceptive use and lack of skilled medical professionals to assist during delivery.
Forgotten and vulnerable
Ironically, access to reproductive health care often declines after a ceasefire because, once peace is forged, humanitarian agencies often stop providing emergency assistance. Yet in post-conflict settings, broken-down infrastructures and a lack of resources often mean that displaced populations are left to try to reconstruct their communities without the necessary supplies and equipment.
“The survey goal,” according the report, “is to highlight the critical need to continue funding and building programmes during a time when traditional humanitarian aid has ceased and development has not yet begun, leaving the population without essential public health services.”
Photo to the right: Members of the survey team from Liberia being trained on how to interview survey participants. Photo: UNFPA
This is very important in Lofa, where only 14.5 per cent of respondents showed comprehensive knowledge of prevention and transmission of HIV/AIDS. Safe patterns of sexual behaviour are even less common, according to the survey.
Sharing data to support NGOs
In many crisis-affected regions, local non-governmental organizations (NGOs) provide the only reproductive health services in a community. It is NGOs which are likely to remain long after international relief organizations have left. Therefore, building the capacity of local partners is a crucial step in ensuring sustainable and quality reproductive health services to vulnerable populations.
“Local NGOs are well-suited to provide reproductive health services because they are intimately aware of the needs and priorities of the communities. They also know the culture, which helps them address sensitive reproductive health issues in a way that more effectively engages community members.
The Lofa County initiative linked population-based data directly to JSI’s Reproductive Health Response in Conflict Capacity Building Programme, which supports and encourages national and local NGOs offering reproductive health services to — or planning to offer reproductive health interventions for — populations affected by conflict.
“For JSI's Capacity Building Program, this was a unique opportunity for our Liberian NGO partners to interact with the research team and to enhance the use of quality data to inform and guide their programmes. The research and implementation teams exchanged perspectives and shared information throughout each stage of the research,” said Molly Fitzgerald, JSI’s Capacity Building Advisor.
For example, even at the data collection stage, JSI met with interviewers to discuss reproductive health from a programmatic standpoint. The research team met later with NGO implementers to “translate” survey findings. Gaps identified through the survey were addressed by ensuring that small grants were available for implementation activities.
Good data can save lives
Three of the four NGOs to receive grants, MERCI, PARACOM and ChildrenSmile, are currently working to address the unmet family planning needs identified in the survey. About a third of married women expressed a need for services, although the contraceptive prevalence rate was reported as 6.8 per cent. The fourth NGO, PMU, is working with the community on obstetric care, so that fewer women die from childbirth-related causes.
“In addition to filling gaps in eproductive health services in a particular area, these NGOs often fill gaps in geographic coverage. For example, ChildrenSmile operates in a remote region of Liberia. It is one of the only reproductive health service providers in the area, and it works closely with county health officials, women's associations, teachers and hospital administrators. They have taken a leadership role in this community, and they have shared the information and resources we gave them,” Mr. Beatty explained.
Although these NGOs are providing desperately needed reproductive health services to communities in Liberia, there are still large populations of women throughout the world dealing with post-conflict issues and the consequences that result from unmet reproductive health needs. Good data is necessary in order to assess what is needed for planning, funding and implementing community-based programmes for humanitarian response and post-crisis settings.