Liberia: Nine Out of Every Ten Women Take Antibiotic Every Month a Survey Finds – Experts Describe Findings As ‘Catastrophic’ for All Liberians

On a recent weekday, L. had just ended her four days of monthly menstruation. The next day the 18-year-old walked into a small drug store beside the main road here as she does every month. With no prescription, she asked the drug dispenser for the antibiotic metronidazole, known as white flagyl..

After asking briefly what her symptoms were the dispenser handed over the medication. FrontPage Africa/New Narratives is only using the woman’s first initial to protect her from stigma.

L. was just doing what more than nine in every ten women in Liberia are doing every month according to an alarming new survey by FrontPage Africa/New Narratives. 109 women from rural and urban Montserrado were approached at random to take part in the survey (results are available at this link) in January and February this year. Medical experts were shocked.

“It’s an alarming report,” says Dr. Plenseh McClain, chairperson of Medicinal Chemistry at the University of Liberia. “Liberia is going to have a serious resistance. The medication that should be serving the purpose for that particular bacterial infection, it’s not going to be serving the purpose. We are talking about nine out of ten say they took antibiotics without prescription. So everyone, the entire country, we must treat that as an emergency.”

The misuse of antibiotics in Liberia has long troubled the medical community. There is growing evidence that the medicines Liberians rely on to treat major infections like malaria, typhoid, diarrhea, no longer work for patients. They will be left to fight those deadly infections on their own.

A 2021 study by the Washington University found that the number of premature deaths associated with antimicrobial resistance that year was more than 4,000, making it the fifth largest killer of Liberians. Experts say it has almost certainly grown worse in the five years since then.

“We are putting ourselves at risk,” says Joseph Sonwarbi, pharmacologist and former chairman of the House of Representatives’ Committee on Health. He says the results of the survey scared him.

“If you become sick and you cannot get the treatment for it, what is the outcome? Death.”

Microbials are tiny living organisms–like bacteria, viruses, and fungi–that are too small to see but can make people sick by causing common illnesses such as malaria, diarrheal diseases, respiratory infections, skin infections.

Antimicrobials are medicines that help our bodies fight off these microbials–so people can stay healthy and infections don’t spread in the communities. The Ministry of Health says there is no national data to show the number of Liberians who are being affected by this but that common infections like pneumonia, urinary tract infections, and diarrhea are among the top five infections that have become harder to cure in the country.

It is potentially catastrophic for Liberian women who are already facing a range of major health challenges and a broken health system. Experts say taking antibiotics every month is not just unnecessary — it’s harmful. Each course wipes out beneficial bacteria in the gut and vagina, and with monthly use, the body never fully recovers between rounds.

Over time, this disrupts blood sugar regulation, weakens the immune system, and raises the risk of chronic conditions like heart disease and type 2 diabetes. It also destroys the protective bacteria in the vagina, ironically making women more vulnerable to the yeast infections and bacterial vaginosis the drugs are supposed to prevent.

Repeated use also raises the risk of severe gut infection that causes persistent diarrhea and can be life-threatening.

The survey puts a spotlight on the alarming failure of governments to educate Liberians about their bodies and basic medicine. With low levels of sex education they have been left at the mercy of misinformation. Three in every five survey participants said they took the antibiotics in the mistaken belief that a period was an infection. Others said they took the antibiotic to remedy stomach pain or headache. Doctors say both are incorrect.

“Your body is a very complicated machine that has its own perfect cleansing system,” says Dr. Su Mon Thaw, a reproductive health expert working in Liberia. “You don’t need to clean it from the outside. Just eat healthy and beware that you are on your period.”

A period is the monthly bleeding that happens to girls and women, when the uterus, the place where a baby can grow, builds a soft lining in anticipation of a fetus every month. The ovaries release an egg through a tube toward the uterus and if the egg is not fertilized by a sperm for pregnancy to happen, the body sheds the lining of the uterus, which comes out as blood.

“In the case that the baby does not come, the egg will be absorbed back into the body through a natural process,” Dr. Thaw says. “All of that preparation that you have had come out from the uterus through your vagina and out of your body.”

Concerningly, the misinformation is also spread by health practitioners. L.’s mother told her to take the antibiotics each month. Her mother is a nurse. Six percent of survey participants said they also received the advice to take the antibiotics from a health practitioner.

In mid-February FrontPage Africa/New Narratives was granted an interview by the office of Augustus Walker, director of Communications and Health Promotion at the Ministry of Health’s Family Health Division, to discuss the survey. It was cancelled a few minutes before the interview began. This reporter was directed to send a letter requesting an interview to Dr. Louise Kpoto, the minister of health. The minister has not responded to the letter or to numerous follow up requests.

Doctors Warn That Longterm Antibiotic Misuse Can Cause Many Long-Term Health Problems

Unlike L. who knows exactly why she is taking the drugs, 35-year-old S. has no idea why she takes eight doses of antibiotics each day, for three days, every month. (Flagyl and amoxicillin were the most commonly cited medicines in the survey). She has been self-medicating after her period, under the advice of friends from high school nearly 20 years ago.

“I don’t have any idea on it,” says S. “I just feel like when I take it after the menstruation, it will clean my system. Maybe infection there, it will clean it up.”

She has been trying to get pregnant for years but is yet to conceive. She desires two children and has started making doctors’ visits about the problem, while at the same time trusting in God. She is confused and does not know if the drugs could be playing a part in her predicament.

Doctors say it could well be. Repeated antibiotic use can affect a woman’s ability to have children. Every monthly course wipes out the good bacteria in the gut that help regulate estrogen, the hormone that controls ovulation and supports pregnancy.

“Hormones have to be balanced so that a woman can get pregnant,” says Dr. McClain. “So if that is not happening, fertility issues will come in.”

Antibiotics also destroy the protective bacteria in the vagina that early evidence suggests play a role in successful fertilization and implantation. The science is still emerging, but the direction is consistent – for a young woman following this practice, the consequences may not show up for years — but by then, the damage can be done.

Dr. McClain says this could also affect the unborn child of a pregnant woman. A woman may not know she is pregnant in the early weeks — but Flagyl crosses the placental barrier, and can increase risk of miscarriage. If the pregnancy continues, a mother’s chronically disrupted gut microbiome is passed to her baby, meaning the child starts life with fewer of the beneficial bacteria linked to healthy immune development. Babies born to mothers with antibiotic-resistant bacteria can inherit that resistance — so if the newborn develops a serious infection, treatment may not work. Infections in newborns can be fatal.

The survey showed ignorance is deeply rooted and causing unnecessary suffering. One in three survey participants said they took the antibiotics to treat pain. L says she cannot stand the pain that comes with her period. She takes antibiotics to get through it, starting with white Flagyl and adding other types on top when the pain gets bad. She believes the drugs are working because her urine turns from yellow to white — a sign, she says, that her body is being cleaned.

But doctors say antibiotics do not relieve period pain. And the change in her urine color is not a sign of cleansing. It is a sign that the drugs are already altering her body’s chemistry. What L. is experiencing is real pain that deserves real treatment.

Period pain happens when the uterus tightens to shed its lining, releasing chemicals that cause cramping and trigger pain that can spread to the back and legs. It is perfectly normal and very rarely caused by an infection.

“These women have normal menstrual symptoms, and they are treating it wrong,” Dr. Thaw says. “They should have taken other medications that are directly intended for those kinds of symptoms. Not the antibiotics.”

Dr. Thaw says women should start with pain killers like paracetamol/acetaminophen or ibuprofen, take them as described on the packaging, and go to see a doctor if they do not work.

Teachers and Nurses Among Those Spreading False Information About Menstruation

The misinformation is widespread. 11th grader L. says her biology teacher – who should know the facts about reproductive health – taught her that a period is a product of spoiled eggs.

“According to my biology teacher, the eggs that are in our stomach, when they get rotten, when they are coming out, that’s what can bring the infection,” L. says. “So, after it, that’s why you supposed to take the medicine to bring all the bad things out.”

Dr. Thaw urges women to learn about their period and calls on health workers to own up some part of the responsibility, to ensure that people are protected and educated.

“It’s sad that nobody has actually taken the time to explain what a period is to them,” Thaw says. “And as women, we have the right to know our bodies. I feel bad about that.”

Dr. Thaw urges women to call a health care center established to give advice on the number 5585 and she wants healthcare sector to work harder at spreading the facts.

“It doesn’t have to come in formal ways. It can be coming from different media,” Dr. Thaw says. “We just have to be more creative on getting the information to the people.”

But S. says countering the misinformation will be difficult as long as cost is a factor.

“People will look at their hand, they say ‘ah, but I only get $L200,”‘ she says. “What time I will go to the hospital for doctor to tell me say, let the paper here, go buy antibiotic.”

But experts say if the country wants to prevent growing suffering for women and children and avoid the potentially catastrophic health outcomes of having no effective antibiotics, the government has no choice but to educate the population now.

By FrontPageAfrica.