Birth and death in Sierra Leone

By Katie Hamann 11 December 2009, 02:35PM

A pregnant woman attends the launch of the campaign to stop maternal mortality in Sierra Leone, September 2009 © AI

The birth of a child should be a cause for celebration: of new life and of women’s sacred role as mother and nurturer. Tragically, many women in Sierra Leone spend the final months of pregnancy and agonising hours of childbirth fearing for their lives.

Sierra Leone has one of the highest rates of maternal mortality in the world - one in eight Sierra Leonean women dies from treatable complications during pregnancy and childbirth.

"These grim statistics reveal that maternal deaths are a human rights emergency in Sierra Leone," said Amnesty International’s Secretary General, Irene Khan. She travelled to Sierra Leone in September to launch the report Out of reach: the cost of maternal health in Sierra Leone (pdf 1.1MB).

"Women and girls are dying in their thousands because they are routinely denied their right to life and health," she said, "in spite of promises from the government to provide free healthcare to all pregnant women."

Low status

Women in Sierra Leone confront discrimination in all aspects of their life. Their low status is refl ected in the lack of priority given to their health needs and the denial of their right to make decisions about how, when and where they want to have a child.

Laws prohibiting domestic violence and child marriage are routinely flouted. Girls as young as 10 are married. These girls are at particular risk of complications - pregnancy related deaths are the leading cause of mortality worldwide for girls 15 to 19 years of age.

It is widely believed in Sierra Leone that an obstructed labour is caused by a woman’s infidelity. Time is often wasted trying to extract a confession instead of getting the woman, in agony and unable to deliver her child, access to emergency obstetric care.

Broken healthcare system

"We must be the only tertiary level maternity hospital on the planet without a functioning sonogram [ultrasound] machine."

A doctor at Princess Christian Maternity Hospital, Freetown.

Healthcare centres and hospitals across the country are woefully understaffed and ill-equipped for managing emergencies. Amnesty International’s research found that not one primary healthcare facility provides basic emergency obstetric care because staff are not trained to perform assisted natural deliveries.

Many hospitals also have no running water and only 10 per cent have a reliable electricity supply. Doctors and nurses told Amnesty International that they frequently wait many months for their salaries, which means they have no choice but to charge for their services. Corruption is rampant but desperate patients have little choice except to pay the fees demanded.

Poverty barrier

The decision to access healthcare is made more difficult by crippling and pervasive poverty.

More than 70 per cent of Sierra Leone’s people live on less than $1 a day. Yet according to the UN Children’s Fund, Sierra Leoneans pay more for healthcare than anyone else in sub-Saharan Africa. This is despite a 2002 Presidential decree exempting pregnant and lactating women from having to pay for healthcare.

Women in Sierra Leone need access to good quality antenatal care and need prompt access to emergency obstetric care when complications arise. They also need the government to ensure that their family’s poverty will not prevent them getting the life-saving treatment they need.

As a signatory to many of the human rights treaties that guarantee a woman’s right to healthcare, the Government of Sierra Leone has an obligation to take targeted steps to guarantee the highest attainable standard of health.

Needless loss: Adama Kamara

Adama Kamara was 25 when she went into labour prematurely in December 2008 in the village of Kapairo.

She struggled in agony to deliver the baby for two days before her family took her to a government hospital.

The trip cost $16, which her husband borrowed from neighbours. At the hospital Adama Kamara had to pay $1 for registration and $4 for a hospital bed, in addition to charges for medicines. There was no doctor on duty.

Adama Kamara delivered her child the next day, but it did not survive. She was bleeding heavily. Despite the fact that this was an emergency situation and despite the government’s free healthcare policy, the nurse in charge told Adama’s husband, Pa Abu Kamara, that he had to pay for medicine for Adama or "she will die".

Pa Abu Kamara told Amnesty International: "I didn’t have any more money. I just took Adama out of the hospital and took her home. She did not look good, but also I did not want to pay the hospital charge for her body, which is at least $26".

Adama Kamara was too delirious to speak for herself. She died at home the next day.

More information

Sierra Leone: No woman should die giving birth - News, 22 September 2009

KATIE HAMANN is a regular contributor to the Human Rights Defender.

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