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Maternal Health Care in the Time of Ebola: A Mixed-Method Exploration of the Impact of the Epidemic on Delivery Services in Monrovia


  • Gizelis, Theodora-Ismene
  • Karim, Sabrina
  • Østby, Gudrun
  • Urdal, Henrik


Public health emergencies like major epidemics in countries with already poor health infrastructure have the potential to set back efforts to reduce maternal deaths globally. The 2014 Ebola crisis in Liberia is claimed to have caused major disruptions to a health system not fully recovered after the country’s civil war, and is an important and relevant case for studying the resilience of health systems during crises. We use data on the utilization of maternal health care services from two representative surveys, one conducted before the outbreak of Ebola, the 2013 Liberian DHS, and another, smaller survey conducted in Monrovia in December 2014, during the height of the epidemic. We focus exclusively on data for women aged 18–49 residing in urban Monrovia, restricting our samples to 1,073 and 763 respondents from the two surveys respectively. We employ a mixed methods approach, combining a multinomial logit model with in-depth semi-structured interviews. Our regression analyses indicate that deliveries in public facilities declined whereas they increased for private facilities. Furthermore, overall facility delivery rates remained stable through the Ebola epidemic: the proportion of home births did not increase. Drawing on insights from extensive qualitative interviews with medical personnel and focus groups with community members conducted in Monrovia in August–September 2015 we attribute these survey findings to a supply side “substitution effect” whereby private clinics provided an important cushion to the shock leading to lower supply of government services. Furthermore, our interviews suggest that government health care workers continued to work in private facilities in their local communities when public facilities were closed. Our findings indicate that resources to shore up healthcare institutions should be directed toward interventions that support private facilities and health personnel working privately in communities during times of crisis so that these facilities are safe alternatives for women during crisis.

Suggested Citation

  • Gizelis, Theodora-Ismene & Karim, Sabrina & Østby, Gudrun & Urdal, Henrik, 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, Elsevier, vol. 98(C), pages 169-178.
  • Handle: RePEc:eee:wdevel:v:98:y:2017:i:c:p:169-178
    DOI: 10.1016/j.worlddev.2017.04.027

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    References listed on IDEAS

    1. Daniel Aldrich, 2011. "The power of people: social capital’s role in recovery from the 1995 Kobe earthquake," Natural Hazards: Journal of the International Society for the Prevention and Mitigation of Natural Hazards, Springer;International Society for the Prevention and Mitigation of Natural Hazards, vol. 56(3), pages 595-611, March.
    2. Bellows, John & Miguel, Edward, 2009. "War and local collective action in Sierra Leone," Journal of Public Economics, Elsevier, vol. 93(11-12), pages 1144-1157, December.
    3. Theodora-Ismene Gizelis, 2011. "A Country of their Own: Women and Peacebuilding," Conflict Management and Peace Science, Peace Science Society (International), vol. 28(5), pages 522-542, November.
    4. World Health Organization & UNICEF & UNFPA & World Bank Group & United Nations, 2015. "Trends in Maternal Mortality," World Bank Publications, The World Bank, number 23550.
    5. repec:cup:apsrev:v:103:y:2009:i:02:p:231-247_09 is not listed on IDEAS
    6. Jacob Hughes, Amanda Glassman, and Walter Gwenigale, 2012. "Innovative Financing in Early Recovery: The Liberia Health Sector Pool Fund - Working Paper 288," Working Papers 288, Center for Global Development.
    7. Luginaah, Isaac N. & Kangmennaang, Joseph & Fallah, Mosoka & Dahn, Bernice & Kateh, Francis & Nyenswah, Tolbert, 2016. "Timing and utilization of antenatal care services in Liberia: Understanding the pre-Ebola epidemic context," Social Science & Medicine, Elsevier, vol. 160(C), pages 75-86.
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    Ebola; maternal care; health; Monrovia; Liberia;


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