Making strides to improve maternal health in Sierra Leone

Making motherhood safer in one of the most dangerous places to give birth

By Harriet Mason
Zainab holds her baby boy few hours after giving birth to him.
UNICEF Sierra Leone/2016/Mason
26 May 2016

Sierra Leone has the highest maternal mortality ratio in the world, making it one of the most dangerous places to give birth. In partnership with the EU, UNICEF is working with trained health workers like Sister Josephine Pewa to reverse these trends in child and maternal health.

FREETOWN, Sierra Leone, 26 May 2016 – It’s antenatal care day at the George Brook Community Health Centre in Sierra Leone’s capital Freetown. A group of pregnant women chat and giggle as they sit on a long wooden bench in the corridor, each waiting her turn to see the midwife. In the delivery room, 28-year-old Zainab Turay struggles to handle the pain as her second child makes his way into the world. A few hours later, she gives birth to a healthy boy and smiles to the health staff who have seen her regularly over the past eight months at the clinic’s free antenatal sessions.

“I believe I gave birth successfully because I came to clinic from the start of my pregnancy and followed all the advice given to me,” says Zainab.

Becoming a mother is a source of joy, pain, love, and a lot more besides. But for many women, it can be life-threatening: childbirth remains among the leading causes of death for women globally. A recent report entitled Trends in Maternal Mortality by WHO, UNICEF, UNFPA, the World Bank Group and the United Nations Population Division estimates that in 2015 alone around 303,000 women died as a result of pregnancy or childbirth, leaving hundreds of thousands of children motherless.

With 1,360 mothers dying per 100,000 live births, Sierra Leone has the worst maternal mortality ratio in the world. According to the latest estimates from 2015, 1 in 17 mothers in Sierra Leone has a lifetime risk of death associated to childbirth. That’s a key concern for UNICEF and the European Union, who are working in partnership to tackle the issue through investment in training, equipment and medical supplies.

Reaching the hard-to-reach

Sister Josephine Pewa is the midwife in charge of the maternity wing at the George Brook Health Centre. She works hard to keep mothers safe during pregnancy and childbirth, but unlike Zainab, many women never even make it to a health facility to give birth. That means they are a long way from professional help should any complications arise. In rural parts of the country, many women continue seeking services from Traditional Birth Attendants (TBAs), who are not skilled to address the major killers of mothers.

“Post-partum haemorrhage (bleeding after childbirth) is often not properly handled outside equipped health facilities,” she says. She adds that bleeding is a major cause of maternal death especially in isolated and hard to reach parts of the country where women have access only to basic health services.

Pregnant women waiting to receive antenatal care at George Brook Community Health Centre
UNICEF Sierra Leone/2016/Mason
Pregnant women waiting to receive antenatal care at the George Brook Community Health Centre. UNICEF and the EU are supporting free antenatal and postnatal services to encourage women to come to health facilities when they get pregnant.

As part of the recently adopted Sustainable Development Goals, the global maternal mortality ratio needs to be reduced to less than 70 per 100,000 live births by 2030. To achieve this target in Sierra Leone, a large number of pregnant women will need to have equitable access to high quality care by skilled personnel during pregnancy and childbirth.

With EU funds, UNICEF has been supporting the training of health workers to build their capacities. This support includes the provision of the equipment and supplies they need to deliver quality health care and to ultimately improve maternal, newborn and child health services. UNICEF also provided support for five doctors, including obstetricians and gynaecologists, to undertake further studies in Ghana to enhance their skills and knowledge in maternal health service delivery.

The existing shortage in skilled health workers in Sierra Leone, which has been aggravated by the Ebola outbreak, might also negatively affect the provision of health services. A recent Policy Research Working Paper 'The Next Wave of Deaths from Ebola?' estimates that the reduced number of health personal after the epidemic could cause maternal mortality to increase by 74 per cent in Sierra Leone.

Improving access to care and medicine

Beyond staff training and equipment, a key goal is to ensure that at least five fully functional Basic Emergency Obstetrical and Neonatal Care (BEmONC) centres and one Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) centre are available in every one of Sierra Leone’s 14 districts. In December 2015, 16 separate construction and rehabilitation projects started across the country, funded by the European Union through UNICEF, to improve basic health infrastructure including maternal facilities.

A significant share of EU support is channelled to the country’s Free Health Care Initiative which includes the free provision of medical supplies to ensure pregnant women deliver safely, as well as free medicine for pregnant women, lactating mothers and children below the age of 5.

“We are really grateful for all the interventions that have been brought to address maternal death in our country,” says Sister Josephine. She also says that the support has been vital: “The free antenatal and postnatal services encourage women to come to health facilities when they get pregnant and is helping us to gradually reduce maternal mortality.”