How the Maternal Mortality Rate is Decreasing in Sierra Leone

The capital of Sierra Leone, Freetown is historically known for being home for freed
slaves during the transatlantic slave trade, giving Sierra Leone a prominent place in history.
However, the small west African country boarding Guinea has faced many adversities. One is
the significant increase in adolescent pregnancies and fertility being some of the highest in the
world. For women and young women, the harsh actuality is that they have “a 1 in 17 lifetime
chance of dying during pregnancy, delivery, or its aftermath.”
https://www.pih.org/article/merging-local-birth-practice-modern-medicine-sierra-leone. This
article will discuss the main reasons as to how the maternal mortality rate is decreasing in
Sierra Leone.

Data Behind the Mortality Rate

For the government of Sierra Leone, keeping a consistent record of deaths was nearly
nonexistent during the Ebola outbreak until the epidemic ended so many lives that it became
preposterous not to report. According to an article by Financial Times, Dr. Sesay, who is “the
government’s director of reproductive and child health,” conducts the government’s response to
the maternal deaths. https://www.ft.com/content/8205b21e-7b44-11e6-ae24-f193b105145e.
According to Dr. Sesay, procedures are set out to lower the maternal mortality rate in Sierra
Leone. “We’ve put in place a maternal death surveillance and response team, and developed a
technical guideline. When a death is reported, they go and confirm.”
https://www.ft.com/content/8205b21e-7b44-11e6-ae24-f193b105145e.

Part of the surveillance is ensuring that reporting the deaths is imperative. Part of doing
so requires health workers within communities to report the deaths to major health facilities.
Furthermore, this is vital to how the maternal mortality rate is decreasing in Sierra Leone
because it ensures that all families are accounted for and not misrepresented in the sample
population. However, the same health workers reporting the data are the same ones attempting
to save these expectant mothers’ lives.

Looking at the Numbers

Maternal mortality in Sierra Leone had reached 1,070 deaths during the timeframe of
January to June of 2020. According to a report by the ministry of health and sanitation in Sierra
Leone, from January to March of 2020, there was a total of 581 maternal deaths. While from
April to June of 2020, the total was 489 maternal deaths. https://mohs.gov.sl/wp-
content/uploads/2020/09/Data-bulletin_Jan-June2020_3-1.pdf.

Equally as important, the predominant reference of data for maternal deaths is CRVS
(Civil Registration and Vital Statistics).The issue is that Sierra Leone doesn’t recognize this
system of data reporting. When this occurs, other data systems are created, such as surveys
and various studies, which leaves more room for inaccurate information. The organization’s
WHO (World Health Organization), UNICEF (United Nations International Children’s Emergency
Fund), UNFPA (United Nations Population Fund) and The World Bank Group have collectively
concluded that not all deaths can be recorded due to “systematic error.” Meaning the data
presented won’t be accurate due to the actual number being lower or higher and this will impact
how the maternal mortality rate is decreasing in Sierra Leone.

However, when using CRVS, “records will be systematically lower than the true number,
because there will always be deaths that go unreported. This is referred to as systematic error.”
https://apps.who.int/iris/bitstream/handle/10665/194254/9789241565141_eng.pdf;jsessionid=61
21C0B102E8B47735D9630EFDE7B8EF?sequence=1. Along with systematic error, there is the
possibility of random error. Meaning when a health worker records inaccurate information, this
increases the inaccuracy of maternal deaths in Sierra Leone. Considering health workers are
underpaid and overworked, random error is present in recording maternal deaths.

How to Make it Better

There are multiple ways as to how the maternal mortality rate is decreasing in Sierra
Leone. However, today’s most beneficial way is by increasing and encouraging education for
TBA’s (traditional birth attendants). Undergoing childbirth for many women in Sierra Leone in
the past, meant being at home and a TBA being present. Usually, a TBA was an elderly woman
from within the community and often referred to as “auntie” or “mother.”
https://www.pih.org/article/merging-local-birth-practice-modern-medicine-sierra-leone. Although
this may sound beneficial and comfortable, such as having a midwife or doula, however,
according to the government, they were the primary reason for the country’s maternal deaths.

If patients were to have any complications during delivery, the TBA would inform the
patient that emergency transportation would take too long to arrive and going to the nearest
clinic would take too much time. In most cases, when healthcare officials would arrive, it would
be too late because the patient has bled out. The government attempted to resolve this issue by
ratifying a law in 2010 forbidding TBA’s to assist in deliveries outside of a clinical environment. If
a TBA and anyone else taking part in the process, including the expectant mother were caught
defying this law, they would face extreme retribution. https://www.pih.org/article/merging-local-
birth-practice-modern-medicine-sierra-leone.

Established in 2001, the nongovernmental organization IsraAID is working towards

providing “emergency and long-term development settings in 50 plus countries.”
https://www.israaid.org/about. The organization also has a medical care program that targets
“reproductive health,” along with expanding educational opportunities.
https://www.israaid.org/about. For the maternal mortality rate to decrease, the government of
Sierra Leone has to recognize how valuable and important reporting data is and continue to
recognize education is critical for TBAs to be successful at their job.

-Montana Moore

Photo: Flickr