In the rural areas of Sierra Leone, Traditional Birth Attendants (TBAs) continue to advise women despite not being trained to deal with the many complications that can arise in pregnancy, such as bleeding after childbirth.
By Amy Fox
In Sierra Leone, the maternal mortality ratio improved from 1682 deaths per 100,000 live births in 2000 to 443 by 2020. Maternal health continues to be an area of focus when considering health care. Maternal deaths are the cause of 36% of all deaths of women aged 15 to 49 in Sierra Leone. Causes of maternal deaths include hypertension and obstetric haemorrhage. The COVID-19 pandemic exacerbated the problems of maternal and child health, with economic growth slowing and disrupting essential health services.
Changing Approach: Skilled Antenatal Support
Zainab Turay, a 28-year-old mother, says the birth of her second child was successful because she regularly attended the free antenatal sessions at Freetown’s George Brook Community Health Centre. In the rural areas of Sierra Leone, Traditional Birth Attendants (TBAs) continue to advise women despite not being trained to deal with the many complications that can arise in pregnancy, such as bleeding after childbirth. Antenatal classes help prepare women for childbirth. Between 2013 and 2017, the number of births delivered by skilled attendants increased by 32%.
Integrating Technology to Improve Maternal Care
In March 2023, the United Kingdom’s Foreign, Commonwealth and Development Office published its International Women and Girls Strategy 2023 to 2030. The strategy is centered around the rights of women to basic freedoms. The Saving Lives in Sierra Leone program is one example of how reproductive rights are being prioritized. Over one year, 1284 midwives received training. Alongside this, the Emergency Obstetric and Newborn Care scheme mentored 260 healthcare workers. This additional training and mentoring has strengthened the number of people trained to deal with issues that arise during pregnancy and after childbirth.
In Sierra Leone, 41% of emergency obstetric and newborn care facilities lack access to one or two basic EmONC signal functions. Therefore, the Saving Lives in Sierra Leone scheme aims to provide these facilities to create quality care. The country trained 949 midwives at the end of 2019, but estimates suggest that 3,000 are needed to adequately care for women. This significant increase in trained midwives reflects the achievement of the Saving Lives program.
Sierra Leone launched the Pregnancy Registration and Service Tracking application (PReSTrack) on July 2, 2024. This application enables real-time tracking of pregnancies and flags high-risk conditions. Moreover, PReSTrack is part of Sierra Leone’s mission to decrease the maternal mortality ratio (MMR) to below 300 deaths per 100,000 live births by 2025. The use of this technology aims to make health care more efficient.
Project HOPE’s Effect
Project HOPE is a global health and humanitarian NGO making significant strides in improving maternal health in Sierra Leone. The organization offers courses such as Helping Babies Breathe and Helping Mothers Survive, training health workers to manage complications. It also established the country’s first Kangaroo Mother Care (KMC) units. With a scarcity of incubators in Sierra Leone, KMC, which involves wrapping premature babies skin-to-skin with their mothers, is vital for saving lives. Given that there are only 0.7 doctors available per 10,000 people, the work of Project HOPE is crucial.
In December 2021, the World Bank approved $60 million to enhance maternal and child health services in Sierra Leone. This will be achieved through the Sierra Leone Quality Essential Health Services and Systems Support Project. The initiative supported two million people. Of the total funds, $10 million targeted the consequences of the global pandemic, providing COVID-19 tools and ensuring that the most vulnerable received the essential health services they needed.
The Future of Maternal and Child Health
The future of maternal and child health in Sierra Leone looks optimistic, due to the efforts of NGOs and other groups. Initiatives like Saving Lives in Sierra Leone and applications such as PReSTrack are enabling more people to access vital health care, thereby improving maternal and infant mortality rates.
