| Summary: | Over 500,000 maternal deaths occur globally each year. Over half of these deaths take place in sub-Saharan Africa. The purpose of this study was to understand the sociopolitical and cultural context of childbirth in Liberia including practices, beliefs and traditions that influence maternal health, illness and death. The concepts of vulnerability, human rights related to reproductive health, gender-based violence and war trauma within the theoretical perspectives of global feminism provide the framework for this study. Critical ethnography was used to study 10 cases of severe maternal morbidity and eight cases of maternal mortality. Data collection included participant observation, field notes and semi-structured, in-depth interviews with 54 women, family members and community members. Three major themes derived from the data were Secrecy Surrounding Pregnancy and Childbirth; Power and Authority; and Distrust of the Healthcare System. The interpretive theory, Behind the House, generated from data analysis provides an effective way of understanding the larger social and cultural context of childbirth and childbirth related practices, beliefs and traditions in Liberia. It defines the complexity and challenges women in Liberia face in their reproductive health. This interpretive theory moves beyond the biomedical understanding of birth by contextualizing childbirth as a social as well as a biological process. This study provides a starting point for more relevant, sensitive and culturally congruent public health programs and policies to address maternal morbidity and mortality in this population.
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