Sierra Leone
More women die in childbirth in Sierra Leone than any other country in the world. This is a consequence of poverty, the aftermath of war and inadequate provision of health and healthcare services, in particular skilled care at delivery. Huge health and development challenges face Sierra Leone. It is currently last out of the 177 countries listed in the UNDP 2004 Human Development Index. Eighty-Five (85%) of the population currently live in extreme poverty, and access to health services has severely deteriorated. Sierra Leone has the highest maternal mortality rate (MMR) in the world with estimates ranging from 1,800 per 100,000 live births (UNICEF, 1995) to 2,100 per 100,000 live births (UNFPA, 2003). The life expectancy at birth is currently only 46 years (UNICEF 2006), and infant and under-five mortality rates are as high as 182 and 316 per 1,000 live births respectively (UNICEF 2003). The civil war has been a contributing factor to reducing access to Emergency Obstetric Care (EmOC), which was already problematic.
In Sierra Leone on average one in six women and girls in labour develop complications. Access to skilled attendants, however, is inadequate due to a number of factors. Women and girls often depend on Traditional Birth Attendants who have not been sufficiently trained. Evidence now shows that "skilling up" these attendants does not provide an effective solution and that women and girls need access to professional care. For each woman or girl that dies in pregnancy or childbirth up to 20 more will suffer disability or ongoing medical problems.
Maternity Worldwide recently conducted a preliminary assessment in Sierra Leone and are now working with local partners to develop projects which are designed specifically around the local needs and which complement the existing work of government and other agencies.
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Maternity Worldwide envisages, subject to planning that they would provide a
programme based on the WHO 3 delay model which would aim to improve:
a. Education and knowledge to improve health seeking behaviour
b. Access to services through improved local rural health facilities
c. Provision of skilled attendants and access to Emergency Obstetric Care
