Maternal death investigation: Voinjama District, Lofa County, Liberia, June 2016

Introduction : approximately 830 women die of pregnancy or complications of pregnancy and child birth daily worldwide. The World Health Organization estimates 1072 maternal deaths per 100,000 live births for Liberia, 2015. Maternal death a priority event in Liberia, requiring immediate reporting and investigation. From January to June 2016, Lofa County recorded 12 maternal deaths with three in Voinjama district alone. We investigated a maternal death of a 20-year old high school student which occurred on 25th June, 2016 in Voinjama, to establish the cause of death and make recommendations for appropriate public health action. Methods : the investigation started on June 27, 2016. We reviewed hospital records and interviewed community leaders, friends, parents, and medical staff. Findings were assessed to establish the likely cause of death. Public Health actions were taken and recommendations made based on findings. Results : the deceased was 8 weeks pregnant with no known underlying medical condition. She was impregnated by another person when her boyfriend traveled and she attempted to abort the pregnancy using local oral herbs commonly known as “RPG” (Rocket propelled grenade) on the evening of June 22, 2016. She severe lower abdominal cramps with bleeding per vaginum on June 24 and died June 25, 2016 at 1200am, en route to the hospital. Conclusion : the likely cause of death was hemorrhagic shock from unsafe abortion. Unwanted pregnancy and non-availability of safe abortion services were contributing factors. We conducted reproductive health awareness on unsafe abortion and contraception. We recommended that the Ministry of Health provide counselling and safe abortion services.