The mortality of women in Sierra Leone is significantly higher compared with other developing countries and is ranked among the countries with the worst maternal health indicators. Many of these deaths can be prevented by simple, cost-effective, community-based interventions, but often times, these preventative measures are not taken advantage of by community members (Kanu 2014). In fact, the World Health Organization (WHO) estimates that “88-98% of maternal deaths can be averted with timely access to existing, emergency obstetric interventions” (Gunawardena, 2018). One of the biggest contributors to these high rates of mortality in women is death at or due to giving birth. There are many factors that play into maternal death including: transportation, cost of care, lack of attendant during labor, poorly stocked facilities, lack of access to any health-care, etc. Despite some progress made to fix these issues, Sierra Leone’s lifetime risk of maternal death still remains high at 1 in 21 (Sharkey 2016). Most deaths occur between the third trimester and first week post-delivery. Unfortunately, the exact cause of death is difficult to determine, especially when the mother gives birth at home (Gunawardena 2018).
Historically, Sierra Leone has been dealing with political issues as well, and that is not helping the cause. Severe hostilities have been having adverse effects on health services since the 1990s. Starting in the decade of 1995-2005, investments in the reconstruction of health services have been made. The health sector is now spending about ten percent of the national budget and this has continually been on the rise. Although, even with this spending, the majority of individuals living in desolate and rural areas are still not seeing the benefits of this. Only 42% of births have a skilled attendant present, most people cannot afford the high costs of the services that these newer facilities offer, and because of this, only about 10% of births occur in the health facilities (Oyerinde 2013). There has also been research done to see if spending on ambulances will improve the dilemma that Sierra Leone faces. These motorbike ambulances that were specifically engineered for use on poor roads, have been helping raise awareness on the importance of women in labor. They have also started to help in getting more women to a health facility when location is the main barrier (Bhopal 2012).
From a cultural standpoint, this is an important issue to discuss because it revolves around so many cultural norms. Much of Sierra Leone is in rural, relies on traditional practices, and is opposed to outside views. Similar to the time of Ebola outbreaks, there has been a breakdown of trust between communities and their governments (Pieterse 2015). When families who have been practicing traditional remedies or health services are suddenly faced with all of this “new” information on “better practices” it can be very intimidating. Sierra Leone’s cultural positions are very strong and influential throughout their lives and communities, so when trying to solve this problem, community members and government members must work together to make sure all voices are heard and all options are considered and respected.
From a public health standpoint, the maternal death rates are alarming and very high compared, not only to the rest of the developed world, but also the developing worlds as well. These maternal deaths are not isolated incidents that only occur randomly or without cause. As said before, many of these deaths are almost entirely preventable. This is an issue that, with proper consideration and implementation, can be reduced significantly. If mothers are dying during or just after pregnancy, the community’s death rates are going to continue to rise as well as their orphaned child rates. Without intervention, this issue will never cease.
Bhopal, S.S., Halpin, S.J. & Gerein, N. Emergency Obstetric Referral in Rural Sierra Leone: What Can Motorbike Ambulances Contribute? A Mixed-Methods Study. Maternal Child Health Journal (2013) 17: 1038. https://doi-org.proxy1.cl.msu.edu/10.1007/s10995-012-1086-8
Gunawardena N, Bishwajit G, & Yaya S. Facility-Based Maternal Death in Western Africa: A Systematic Review. Frontiers in Public Health. 2018;6:48. doi:10.3389/fpubh.2018.00048.
Kanu JS, Tang Y, & Liu Y. Assessment on the Knowledge and Reported Practices of Women on Maternal and Child Health in Rural Sierra Leone: A Cross-Sectional Survey. Vallely A, ed. PLoS ONE. 2014;9(8):e105936. doi:10.1371/journal.pone.0105936.
Oyerinde, K., Harding, Y., Amara, P. et al. A Qualitative Evaluation of the Choice of Traditional Birth Attendants for Maternity Care in 2008 Sierra Leone: Implications for Universal Skilled Attendance at Delivery. Maternal and Child Health Journal (2013) 17: 862. https://doi-org.proxy1.cl.msu.edu/10.1007/s10995-012-1061-4
Pieterse, P. & Lodge, T. When free healthcare is not free. Corruption and mistrust in Sierra Leone’s primary healthcare system immediately prior to the Ebola outbreak, International Health, Volume 7, Issue 6, 1 November 2015, Pages 400–404.
Sharkey, A., Yansaneh, A., Bangura, P.S., Kabano, A., Brady, E., Yumkella, F., & Diaz, T. Maternal and newborn care practices in Sierra Leone: a mixed methods study of four underserved districts, Health Policy and Planning, Volume 32, Issue 2, 1 March 2017, Pages 151–16