The social determinant of health that affects the people in Sierra Leone most prominently is that of social exclusion. Social exclusion stems from poverty, discrimination, stigmatization, poor quality housing, limited access to health care services, and poor environment quality (WHO 2003). Many of the people living in Sierra Leone, especially the women and children, are faced with these problems of living under the poverty line, with little access to appropriate care, and seclusion from others. The majority of these things are not a choice. They are circumstances that people fall into time after time, generation after generation. The issue that I am looking into, of maternal death rates, is directly related to this social determinant of health. A pregnant woman experiences many of the repercussions of social exclusion because they are more likely to be in a position of either being dependent on someone else for an income, or being in poverty on their own, or both, many have little access to health care because they are located in rural areas with poor health care or transportation, and many are often isolated to just their husband or certain family members (Whitaker 2012).
Social exclusion is such a problem for Sierra Leone because it is deeply rooted within their cultures. The majority of Sierra Leoneans have no formal education and this is an instant drawback in moving above the poverty line in terms of income. Even more staggering, is that the majority of men and women (54% and 74% respectively) are still illiterate (Statistics Sierra Leone and ICF Macro, 2009). Both of these are causes for the major gap in health care. Seeing that the majority of people are uneducated, they are unable to get decent jobs to make money to support themselves. This puts them in areas that are more rural and desolate compared to urban cities that are inhabited by the educated workforce. Being in rural areas also means that they are further away from main hospitals or health care clinics. This is especially important information when considering maternal health. If women are not able to get to a health care clinic they will not receive the care that they need. Sometimes, even if a woman is near a hospital or health clinic, she is unable to afford the care because she lives below the poverty line. There are also instances where a woman is near a free, government ran health clinic, but will not receive proper care because influential family members do not approve of the “non-traditional” care that a government clinic will offer (Whitaker 2012).
Social exclusion becomes an additional problem because the majority of households have an average of 6 people, with the majority of the members being children under the age of 15 (Statistics Sierra Leone and ICF Macro, 2009). This means that in order to maintain the household, many of the children must work to provide a small portion of income. Having to work at such a young age limits the children from receiving an education and this will ultimately put them in the same position as their parents in the future. Social exclusion becomes a viscous cycle generation after generation because families are continuously trying to just get by as they can. Very few are able to work to better their futures or the futures of their children because they simply don’t have the means to.
Statistics Sierra Leone and ICF Macro. 2009. Sierra Leone Demographic and Health Survey 2008: Key Findings. Calverton, Maryland, USA: SSL and ICF Macro.
Whitaker, Kati. “Is Sierra Leone Right to Ban Traditional Birth Attendants?”. Guardian News and Media. 17 Jan. 2012. https://www.theguardian.com/global-development/poverty-matters/2012/jan/17/traditional-birth-attendants-sierra-leone
WHO. (2003). Social determinants of health: The solid facts. Copenhagen: World health organization, Regional Office for Europe.