Advertisement

Having Belly During Ebola

  • Janice L. CooperEmail author
  • Meekie J. Glayweon
Chapter
Part of the Global Maternal and Child Health book series (GMCH)

Abstract

During the 2014–2016 Ebola outbreak, pregnant women faced challenges accessing care and keeping safe. Many health care facilities closed. The public discourse on the impact of Ebola created fear of pregnant women and fostered stigma and discrimination. Many providers refused to treat to pregnant women, and consequently maternal health care declined. In this study, enrollees were women who were pregnant during the outbreak, who lost pregnancies, who delivered healthy babies, and health care providers who treated women with Ebola. Study participants were recruited based on their experiences in the outbreak and reflected convenience sampling and snowballing. Participation was through a focus group or in-depth individual interviews. Data was coded, tabulated, and analyzed quantitatively and qualitatively based on major themes. Three women who experienced pregnancy and pregnancy loss during the Ebola virus outbreak and seven health care workers who supported women who were pregnant were enrolled. Respondents were deeply impacted by the outbreak—some were infected, and many pregnant women experienced stigma, discrimination, and poor access to care. Women were forced to make tough ethical decisions that led to on-going distress at time when they were experiencing significant psychological problems and trauma. The Ebola epidemic led to personal, psychological, and economic and health system losses, as well as changes in health care delivery. Unfortunately, many of the factors that fueled Ebola’s adverse and disproportional impact on Liberia’s pregnant women persist, and addressing these factors requires urgent action.

Keywords

Pregnancy Ebola Stigma Discrimination Liberia Maternal morbidity Maternal mortality Ebola virus disease Stigmatization Health care workers Survivors Witness accounts 

Notes

Acknowledgments

Janice L. Cooper, PhD, and Meekie Glayweon, MA, worked on the Incident Management System for the Liberia Government’s response to Ebola. Dr. Cooper headed the Psychosocial Pillar and Rev. Glayweon was coordinator of the National Ebola Survivor Network. Reverend Glayweon is with the PREVAIL III Natural History Study, JFK Hospital, Monrovia, Liberia. The University of Liberia PIRE’s IRB approved the research study upon which this article is based. The research for this chapter was approved by the University of Liberia, Pacific Institute For Research and Evaluation Insitution Review Board, UL-PIRE. We thank the participants who were willing to discuss their experiences in Ebola.

References

  1. Arwady, M. A., Bawo, L., Hunter, J. C., Massaquoi, M., Matanock, A., Dahn, B., et al. (2015). Evolution of Ebola virus disease from exotic infection to global health priority, Liberia, mid-2014. Emerging Infectious Diseases, 21(4), 578–584. https://doi.org/10.3201/eid2104.141940. Retrieved March 28, 2018, from https://wwwnc.cdc.gov/eid/article/21/4/14-1940_article.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Baggi, F. M., Taybi, A., Van Herp, M., Di Caro, A., Wofel, R., Gunther, S., et al. (2014). Management of pregnant women affected with Ebola virus in a treatment center in Guinea. EuroSurveillance, 19(49). pii: 20983. Retrieved March 27, 2018, from http://eurosurveillance.org/content/10.2807/1560-7917.ES2014.19.49.20983.
  3. Baize, S., Pannetier, D., Osetereich, L., Rieger, T., Koivogul, L., Magassouba, N., et al. (2014). Emergence of Zaire Ebola virus disease in Guinea. New England Journal of Medicine, 371(15), 1418–1425. Retrieved March 26, 2018, from http://www.nejm.org/doi/full/10.1056/NEJMoa1404505.CrossRefGoogle Scholar
  4. Beigi, R. H. (2017). Emerging infectious diseases in pregnancy. Obstetrics & Gynecology, 129(5), 896–906.CrossRefGoogle Scholar
  5. Dawson, S. (2014). Exclusive: Liberia health system collapsing as Ebola spreads. Reuters News. Retrieved March 26, 2018, from https://www.reuters.com/article/us-health-ebola-liberia/exclusive-liberia-health-system-collapsing-as-ebola-spreads-idUSKBN0G72FC20140807.
  6. Doucleff, M. (2014). Dangerous deliveries: Ebola leaves moms and babies without care. NPR. Retrieved March 26, 2018, from https://www.npr.org/sections/goatsandsoda/2014/11/18/364179795/dangerous-deliveries-ebola-devastates-womens-health-in-liberia.
  7. Evans, D., Goldstein, L., & Popova, A. (2015). Correspondence: Health care worker mortality and the legacy of the Ebola epidemic. The Lancet Global Health, 3, e439–e440. https://doi.org/10.1016/S2214-109X(15)00065-0. Retrieved March 26, 2018, from http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)00065-0/fulltext.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Executive Mansion. (2014). President Sirleaf declares 90-day state of emergency, as government steps up the fight against the spread of the Ebola virus disease. Monrovia: Executive Mansion. Retrieved March 27, 2018, from http://www.emansion.gov.lr/2press.php?news_id=3053&related=7&pg=sp.
  9. Fallah, M., Nyenswah, T., Wiles, W., Baawo, S., Tarpeh, M., Kollie, S., et al. (2015). Communication as the key to guide workforce development in the health sector in public stakeholder partnerships: A case study in Liberia. The Lancet, 2(Special Issue), S43. Retrieved March 28, 2018, from http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)70065-3/fulltext.Google Scholar
  10. Fallah, M. P., Skrip, L. A., Dahn, B., Nyenswah, T., Flumo, H., Glayweon, M., et al. (2016). Pregnancy outcomes in Liberian women who conceived after recovery from Ebola virus disease. The Lancet: Global Health, 4(10), e678–e679. Retrieved March 28, 2018, from http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30147-4/fulltext.Google Scholar
  11. Gizelis, T., Karim, S., Østby, G., & Urdal, H. (2017). Maternal health care in the time of Ebola: A mixed method exploration of the impact of the epidemic on delivery services in Monrovia. World Development, 98, 169–178. https://doi.org/10.1016/j.worlddev.2017.04.027. Retrieved March 28, 2018, from https://www.sciencedirect.com/science/article/pii/S0305750X17301377.CrossRefGoogle Scholar
  12. Henwood, P. C., Bebell, L. M., Roshania, R., Wolfman, V., Mallow, M., Kalyanpur, A., et al. (2017). Ebola virus disease and pregnancy: A retrospective cohort study of patients managed at 5 Ebola treatment units in West Africa. Clinical Infectious Diseases, 65(2), 292–299. Retrieved March 28, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5850452/.CrossRefGoogle Scholar
  13. Hessou, C. (2014). Pregnant in the shadow of Ebola: Deteriorating health systems endanger women. UNFPA. Retrieved March 28, 2018, from https://www.unfpa.org/news/pregnant-shadow-ebola-deteriorating-health-systems-endanger-women.
  14. Index Mundi. (2015). Country comparison: Maternal mortality rates.Google Scholar
  15. Iyengar, P., Kerber, K., Howe, C. J., & Dahn, B. (2015). Services for mothers and newborns during the Ebola outbreak in Liberia: The need for improvement in emergencies. PLOS Currents. https://doi.org/10.1371/currents.outbreaks.4ba318308719ac86fbef91f8e56cb66f. Retrieved March 28, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404271/.
  16. Liberia Institute of Statistics and Geo-Information Services (LISGIS), Ministry of Health and Social Welfare, National AIDS Control Program, & Macro International Inc. (2008). Demographic and Health Survey 2007. Monrovia: Liberia Institute of Statistics and Geo-Information Services (LISGIS) and Macro International Inc.Google Scholar
  17. Lori, J. R., Rominski, S. D., Perosky, J. E., Munro, M. L., Williams, G., Bell, S. A., et al. (2015). A case series study of the effect of Ebola on facility-based deliveries in rural Liberia. BMC Pregnancy and Childbirth, 15, 254. https://doi.org/10.1186/s12884-015-0694-x. Retrieved March 27, 2018, from https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-015-0694-x.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 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), 1–17. https://doi.org/10.1371/journal.pmed.1002096. Retrieved March 29, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970816/.CrossRefGoogle Scholar
  19. Ministry of Health. (2015a). Investment case for reproductive, maternal, newborn, child and adolescent health 2016–2020. Monrovia: Ministry of Health, Republic of Liberia.Google Scholar
  20. Ministry of Health. (2015b). Investment plan for building a resilient health system 2015–2021. Monrovia: Ministry of Health.Google Scholar
  21. Ministry of Health. (2016a). The Republic of Liberia Ebola survivors care and support policy. Monrovia: Ministry of Health, Republic of Liberia.Google Scholar
  22. Ministry of Health. (2016b). Joint annual health sector review report. National Health Sector Investment Plan. Monrovia: Ministry of Health.Google Scholar
  23. Ministry of Health. (2016c). Liberia Service Availability and Readiness Assessment (SARA) and quality of care report. Monrovia: Ministry of Health.Google Scholar
  24. Ministry of Health and Social Welfare. (2011). National Health and Social Welfare Policy and Plan: Final Draft for Validation. Monrovia.Google Scholar
  25. Moddares, N., & Berg, K. (2016). Qualitative assessment on health system trust and health service utilization in Liberia. Baltimore: Johns Hopkins Bloomberg School of Public Health, Center for Communications Programs.Google Scholar
  26. Muchler, B. (2014). Liberia’s JFK hospital reopens after temporary Ebola closure. VOA. Retrieved Match 29, 2018, from https://www.voanews.com/a/liberias-jfk-hospital-reopens-after-temporary-closure/2483132.html.
  27. Mukpo, A. (2015). Surviving Ebola: Public perceptions of governance and the outbreak response in Liberia. International Alert. Retrieved Match 29, 2018, from https://reliefweb.int/sites/reliefweb.int/files/resources/Liberia_SurvivingEbola_EN_2015.pdf.
  28. Otolorin, E., Gomez, P., Currie, S., Thapa, K., & Dao, B. (2015). Essential basic and emergency obstetric and newborn care: From education and training to service delivery and quality of care. International Journal of Gynaecology and Obstetrics, 130, 546–553. Retrieved March 28, 2018, from https://www.sciencedirect.com/science/article/pii/S0020729215001368.CrossRefGoogle Scholar
  29. Paterson, D., & Widner, S. (2017). Offering a lifeline: Delivering critical supplies to Ebola-affected communities in Liberia, 2014–2015. Princeton University. Retrieved March 28, 2018, from https://successfulsocieties.princeton.edu/publications/ebola-delivering-critical-supplies-liberia.
  30. Schwartz, D. A. (2015a). Interface of epidemiology, anthropology and health care in maternal death prevention in resource-poor nations. In D. A. Schwartz (Ed.), Maternal mortality: Risk factors, anthropological perspectives, prevalence in developing countries and preventive strategies for pregnancy-related death (pp. ix–xiv). New York: Nova Science.Google Scholar
  31. Schwartz, D. A. (2015b). The pathology of maternal death—The importance of accurate autopsy diagnosis for epidemiologic surveillance and prevention of maternal mortality in developing countries. In D. A. Schwartz (Ed.), Maternal mortality: Risk factors, anthropological perspectives, prevalence in developing countries and preventive strategies for pregnancy-related death (pp. 215–253). New York: Nova Science.Google Scholar
  32. Schwartz, D. A. (2015c). Unsafe abortion: A persistent cause of maternal death and reproductive morbidity in resource-poor nations. In D. A. Schwartz (Ed.), Maternal mortality: Risk factors, anthropological perspectives, prevalence in developing countries and preventive strategies for pregnancy-related death (pp. 425–439). New York: Nova Science.Google Scholar
  33. Shannon, R. Q., Horace-Kwemi, E., Najjemba, R., Owiti, P., Edwards, J., Shringarpure, K., et al. (2017). Effects of the 2014 Ebola outbreak on antenatal and delivery outcomes in Liberia: A nationwide analysis. Public Health Action, 7(S1), S88–S93. Retrieved March 27, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5515570/.CrossRefGoogle Scholar
  34. Strong, A., & Schwartz, D. A. (2016). Sociocultural aspects of risk to pregnant women during the 2013–2015 multinational Ebola virus outbreak in West Africa. Health Care for Women International, 37(8), 922–942. https://doi.org/10.1080/07399332.2016.1167896.CrossRefGoogle Scholar
  35. Strong, A. E., & Schwartz, D. A. (2019). Effects of the West African Ebola epidemic on health care of pregnant women—Stigmatization with and without infection. In D. A. Schwartz, J. N. Anoko, & S.A. Abramowitz (Eds.), Pregnant in the time of Ebola: Women and their children in the 2013-2015 West African epidemic. New York: Springer.Google Scholar
  36. World Bank. (2016). World Bank group Ebola response fact sheet. Retrieved March 29, 2018, from http://www.worldbank.org/en/topic/health/brief/world-bank-group-ebola-fact-sheet.
  37. World Health Organization. (2015). Liberia: Country cooperation strategy at a glance. Retrieved March 28, 2018, from http://apps.who.int/iris/bitstream/10665/136911/1/ccsbrief_lbr_en.pdf.
  38. World Health Organization. (2018). About save lives: Clean your hands. Retrieved March 28, 2018, from http://www.who.int/gpsc/5may/background/5moments/en/.
  39. Worzi, A. (2014). Redemption hospital worker protest. The Daily Observer. Retrieved March 29, 2018, from https://www.liberianobserver.com/news/redemption-hospital-workers-protest/.

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.The Carter Center Mental Health ProgramMonroviaLiberia
  2. 2.Incident Management Team and National Ebola Survivor NetworkMonroviaLiberia
  3. 3.PREVAIL-III Natural History StudyJ.F.K. HospitalMonroviaLiberia

Personalised recommendations