Around the world, 250 babies are born every minute. And yet, in some parts of the world, pregnancy remains extremely difficult — and dangerous.
In 2013, an estimated 1,165 mothers died for every 100,000 births in Sierra Leone, according to key findings from the same year's Demographic and Health Survey. The country has the highest maternal mortality rate in the world.
This mortality rate is significantly higher than the second, third, and fourth highest rates globally, too: Central African Republic, Chad, and Nigeria see maternal mortality rates that sit in the 800 range, according to the CIA World Factbook.
Why? What has led to the unfortunate conditions for pregnant women in this small coastal West African country?
In 2014, Sierra Leone was one of the West African countries hit the hardest by the Ebola virus, along with Liberia and Guinea. There were more than 14,000 probable cases of Ebola and nearly 4,000 people were killed.
Numbers of people infected continued to flare up until 2016. This strained the already fragile health care system.
In a paper by the World Bank Group, authors estimated that the aftermath of the Ebola crisis increased maternal mortality rates in Sierra Leone by 74%. The weak health care system was underprepared for the outbreak and there was a shortage of staff, as health care workers became infected with the virus.
Recovery from War
Sierra Leone experienced a brutal civil war that lasted for 11 years, from 1991 to 2002, killing more than 50,000 people — in a country composed of about 6 million.
The war also left the country’s healthcare system in shambles. Sierra Leone suffered from massive shortages of health care facilities, medical equipment and supplies, medication, and trained medical personnel. The shortage continued for years after the war ended.
The most recent data indicates that the government spends just over 11% on health expenditures, which is in fact, one of the highest rankings in the world.
Coming in at 11th place, Sierra Leone spends more on health expenditures than Canada, Japan, and the United Kingdom. However, with a chronic shortage of physicians (0.02 available per 1,000 Sierra Leoneans), access to quality health care is extremely hard to come by.
Many women do not make it to a health facility to give birth, according to Sister Josephine Pewa, a midwife at the George Brook Health Centre, in the Western Area Urban District of Sierra Leone.
“Post-partum haemorrhage is often not properly handled outside equipped health facilities,” she told UNICEF.
Bleeding is the leading cause of maternal death especially in isolated areas of the country, according to Pewa.
Prevalence of Female Genital Mutilation
Sierra Leone is one of the 29 countries in the world where female genital mutilation (FGM) is still practised. It’s often performed during a rite of passage ceremony for girls who are transitioning to adulthood.
Sierra Leone has some of the highest levels of FGM in the world, according to a report published this year in the Lancet.
The most recent data indicated that 89.6% of women aged 15 to 49 have undergone FGM, according to the Demographic and Health Survey in 2013.
FGM has many health risks, including infection, immediate pain, shock, and trauma. In the case of maternal health, a procedure performed on a girl can still have devastating long-term effects years later. Some of the health risks include prolonged or obstructed labour, post-partum haemorrhaging, obstetric tears and lacerations, and obstetric fistula.
Obstetric fistula is a preventable condition in which a hole opens between a woman's genital tract and her urinary tract or rectum. It makes up 6% of all maternal deaths, according to the World Health Organization.
Many maternal deaths in Sierra Leone can be prevented with increased education, a focus on the elimination of dangerous practices like FGM, and increasing access to quality maternal healthcare.