Risk and Recognition: The Traditional Midwives Who Filled the Gap in the Time of Ebola

  • Theresa Jones
Part of the Global Maternal and Child Health book series (GMCH)


The chapter focuses on vignettes of three traditional midwives who carried out deliveries in their community when the Ebola outbreak forced their local hospital to close its in-patient services. They operated with little equipment and scant information on infection control, often using plastic bags or rewashing black-market personal protective equipment (PPEs). They worked in an environment of great fear, rumor, and uncertainty, especially regarding the health status of delivering pregnant women. As facilities reopened for delivery, and traditional midwives were being told “no more home deliveries”, these women felt unrecognized by the formal health system and the Ministry of Health for the risks they took and the efforts they made. As influential figures in the community, this resentment can remain a barrier for pregnant women from going to the hospital. The chapter will explore how the system of facility deliveries quickly crumbled during the Ebola epidemic, and people reverted to traditional ways to deliver. It explores what makes these traditional supports able to operate during both the crisis points and the good times for the Liberian formal health system. It recommends greater two-way learning between different approaches to maternal health care, especially as the residual effects of Ebola make the need to work with community-based supporters greater than ever.


Traditional Midwives Traditional birth attendants Ebola Pregnancy Delivery Obstetrical risk Health systems Liberia Midwives Maternal health Ebola virus disease 


  1. Adams, V., Miller, S., Chertow, J., Craig, S., Samen, A., & Varner, M. (2005). Having a “safe delivery”: Conflicting views from Tibet. Health Care for Women International, 26, 821–851.CrossRefGoogle Scholar
  2. Berry, N. (2006). Kaqchikel midwives, home births, and emergency obstetric referrals in Guatemala: Contextualizing the choice to stay home. Social Science & Medicine, 62, 1958–1969.CrossRefGoogle Scholar
  3. Campbell, O. M., & Graham, W. J. (2006). Strategies for reducing maternal mortality. Getting on with what works. Lancet, 368, 1284–1299.CrossRefGoogle Scholar
  4. Chandler, C., Fairhead, J., Kelly, A., Leach, M., Martineau, F., Mokuwa, E., et al. (2014). Ebola: Limitations of correcting misinformation. Lancet, 385, 1275–1277.CrossRefGoogle Scholar
  5. Chapman, R. (2006). Chikotsa—Secrets, silence, and hiding: Social risk and reproductive vulnerability in central Mozambique. Medical Anthropology Quarterly, 20(4), 487–515.CrossRefGoogle Scholar
  6. Costello, A., Azad, K., & Barnett, S. (2006). An alternative strategy to reduce maternal mortality. Lancet, 368, 1477–1479.CrossRefGoogle Scholar
  7. Evans, D. K., Goldstein, M. & Popova, A. (2015). Health-care worker mortality and the legacy of the Ebola epidemic. The Lancet Global Health, 3(8), E439–E440.CrossRefGoogle Scholar
  8. Hayden, E. C. (2015). Maternal health: Ebola’s lasting legacy. Nature, 519, 24–26.CrossRefGoogle Scholar
  9. Keiny, M., Evans, D., Schmets, G., & Kadandale, S. (2014). Health-system resilience: Reflections of the Ebola crisis in western Africa. Bulletin of the World Health Organization, 92, 850. Retrieved November 12, 2017, from Scholar
  10. Jones, T., Ho, L., Kun, K., Shakpeh, J. & Loewenson, R. (2018). Rebuilding people-centred maternal health services in post-Ebola Liberia through participatory action research. Global Public Health, 13(11), 1650–1669. Scholar
  11. Kleinman, A. (1980). Patients and healers in the context of culture. Los Angeles: University of California Press.Google Scholar
  12. LISGIS [Liberia Institute of Statistics and Geo-Information Services], Ministry of Health and Social, Welfare [Liberia], National AIDS Control Program [Liberia], ICF International. (2014). Liberia Demographic and Health Survey 2013. Monrovia, Liberia.Google Scholar
  13. Loewenson, R., Kaim, B., Chikomo, F., Mbuyita, S., & Makemba, A. (2006) Organizing people’s power for health: Participatory methods for a People Centred Health System. PRA toolkit. Ideas Studio, South Africa.Google Scholar
  14. Loewenson, R., Laurell, A. C., Hogstedt, C., D’Ambruoso, L., & Shroff, Z. (2014). Participatory action research in health systems: A methods reader. Harare: IDRC/CRDI Canada and World Health Organization, EQUINET.Google Scholar
  15. Lori, J. R. (2009). Cultural childbirth practices, beliefs and traditions in Liberia (Doctoral dissertation, College of Nursing, University of Arizona).Google Scholar
  16. Ly, J., Sathananthan, V., Griffiths, T., Kanjee, Z., Kenny, A., Gordon, N., et al. (2016). Facility-based delivery during the Ebola virus disease epidemic in rural Liberia: Analysis from a cross-sectional, population-based household survey. PLoS Medicine, 13(8), e1002096. Retrieved November 12, 2017, from Scholar
  17. Mbwili-Muleya, C., Lungu, M., Kabuba, I., Zulu Lishandu, I., & Loewenson, R. (2008). EQUINET Participatory Research Report. An EQUINET PRA project report. Harare: EQUINET. Retrieved November 12, 2017, from Scholar
  18. Miller, L. (2016). Whenever light enters darkness, the places becomes bright. Evaluation of IRC support of the Restoration of Health Services at Redemption Hospital. Liberia: International Rescue Committee.Google Scholar
  19. Ministry of Health & Social Welfare. (2010). National reproductive & sexual health policy. Liberia: Ministry of Health & Social Welfare. Retrieved November 12, 2017, from Scholar
  20. Minor Peters, M. (2014). Community perceptions of Ebola response efforts in Liberia: Montserrado and Nimba counties. Ebola Response Anthropology Platform, 2015. Retrieved November 12, 2017, from
  21. Piper, C. J. (1997). Is there a place for traditional midwives in the provision of community health services? Annals of Tropical Medicine and Parasitology, 91(3), 237–245.CrossRefGoogle Scholar
  22. World Health Organization. (2005). The world health report (2005) —make every mother and child count. Geneva: World Health Organization. Retrieved November 10, 2017, from
  23. World Health Organization. (2010). Working with individuals, families and communities to improve maternal and newborn health. Retrieved October 4, 2017, from
  24. World Health Organization. (2015). Health worker Ebola infections in Guinea, Liberia and Sierra Leone. A preliminary report 21 May 2015. Retrieved November 18, 2018, from

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Theresa Jones
    • 1
  1. 1.International Rescue CommitteeMonroviaLiberia

Personalised recommendations