The chances of dying during childbirth in Sierra Leone are 1 in 17. With an estimated 1,165 deaths per 100,000 live births, the country has one of the highest maternal mortality rates in the world. In comparison, the maternal mortality rate in the United States. is 23.8 deaths per 100,000 live births, meaning women in Sierra Leone are nearly 50 times more likely to die while giving birth than U.S. women.
The small West African country with a population of 6 million people is recovering from a civil war that lasted over two decades and an Ebola outbreak — both of which have weakened the country’s infrastructure.
Mama, come. Take my baby, hold my baby, I’m dying.
The main causes of maternal deaths in the country are postpartum hemorrhaging, pregnancy-induced hypertension, and sepsis. Major obstacles, such as accessing blood transfusions, reaching hospitals in a timely manner, and receiving adequate care from skilled attendants, threaten pregnant women and their babies. According to the World Health Organization, nearly 300,000 women worldwide die annually because of complications from pregnancy and childbirth. The majority of these deaths are preventable.
The following photos provide a glimpse into some of the challenges of and solutions to lowering maternal mortality in a country where giving birth is one of the riskiest things a woman can do in her lifetime.
Midwife Glenys Wusi, 50, performs a routine prenatal check-up for a patient. Glenys encourages women to give birth at the medical clinic, where trained medical professionals can assist in case of complications, instead of at home.
Traditional birth attendants (TBAs) were banned in 2010 from assisting with at-home births in Sierra Leone because of safety concerns. However, many women are uncomfortable in a clinic setting and still choose to give birth at home with a TBA.
Isatu Jalloh, 43, is overcome with emotion as she recalls the moments leading up to the death of her daughter, Kadiatu. Kadiatu, 21, had just given birth at a local clinic when she began hemorrhaging.
“Kadiatu was breathing very heavily. She was lying down,” Isatu says. “As soon as she heard my voice, she said, ‘Mama, come. Take my baby, hold my baby, I’m dying.’”
Kadiatu was in desperate need of a blood transfusion. She was transferred to a nearby hospital but died in an ambulance on the way there.
Alpha Osman Marah, Kadiatu’s son, is exactly one month old. Isatu, became his main caregiver after Kadiatu died. Isatu lives in poverty and as a widow, she’s concerned about providing for her family.
“I have a lot of worries on my mind,” Isatu says. “I don’t have money and I have to start all over again.”
In Sierra Leone, one of every three maternal deaths is due to postpartum hemorrhaging. When women in labor experience complications at community health clinics, they are required to travel to a hospital, which is better equipped to provide medical services. However, it can take hours of travel to reach the nearest hospital.
In 2018, the government launched the National Emergency Medical Service (NEMS), a fleet of nearly 100 ambulances to provide transportation for patients. Long distances from clinics, poor road networks, and bad weather conditions mean it can still take hours to reach a hospital. Some women die on the way.
Mariatu, 15, was walking in her neighborhood one day when she encountered a CARE training about family planning. Curious, she stayed for the meeting, and learned that she was previously misinformed about contraception. Her community sees it as a form of abortion and believes it will make women sterile.
Mariatu decided to take contraception to avoid an unplanned pregnancy. “I feel good that I changed my mind,” Mariatu says. When two of her older sisters became pregnant as teenagers, they were kicked out of the family house and dropped out of school. Her sisters’ experience has encouraged Mariatu to learn about family planning and avoid similar circumstances.
“People in my community misled me and now that I know the truth, I will continue to tell my peers that what people say is not the right thing.”
One in every three teenage girls in Sierra Leone becomes pregnant. Girls and teenagers under 19 years of age make up nearly half of all maternal deaths in Sierra Leone, according to Dr. Abiodun Chris Oyeyipo from UNFPA Sierra Leone. He says reducing teenage pregnancy rate would have a tremendous impact on maternal mortality in the country.
Regina Mahmoud, 45, stands in the maternity ward of a clinic where she works as a community health nurse in Malal, Port Loko.
She helps women have safe deliveries, free of complications. The clinic, which is off-grid, is solar powered. Technical issues and a lack of resources make the solar power unreliable. Sometimes it can be difficult to find enough light when women give birth at night.
“At night when [assisting with deliveries], it is difficult for us. We use our phones,” Regina explains. She often brings a solar-powered portable light from home to light up the maternity ward in the clinic — a simple room with one bed. One bed isn’t enough, she says. There have been instances where up to four women are in labor at the same time.
Isatu Banguru, 37, front center, is a solar engineer and master trainer with the Barefoot Women Solar Engineers Association of Sierra Leone, commonly known as the Barefoot Women. The organization trains women to become solar technicians who assemble and install solar panels in schools, offices, and medical centers.
Oftentimes women give birth in clinics and hospitals that lack electricity. According to estimates, child mortality could be reduced by up to 40% if rural clinics had better lighting for nighttime births.