Giving Birth in Sierra Leone: Not Just Women's Stuff

Sierra Leone should be one of the most prosperous countries in West Africa, with its diamonds, iron ore and bauxite reserves. Yet, the vast majority of its people live in grinding poverty, and the country has the fourth highest maternal mortality rate in the world. On health, though, it is making progress.

The Reverend George Buannie is a powerfully built man, with a voice to match. And in the dirt-poor village of Binkolo, in northern Sierra Leone, he's talking serious stuff to a local farmer.

Not about how tough it is to survive in one of the poorest countries on earth. Not about football, or politics, or any of the other topics that men usually talk about. He is talking about teenage pregnancies, and child marriage, and family planning. "Women's stuff."

Except, says Rev. George, it's not just women's stuff. It's everyone's stuff. "You can't expect to do anything effective about improving women's health and maternal mortality rates if you ignore men," he says. "They want to be involved, they want to know what's going on. If you ignore them, and just have women talking to women, they get suspicious."

In Sierra Leone, the whole "giving birth business" is still widely regarded as a women's issue. Very few men have any idea what's involved - and when they find out, they're appalled. They had no idea. The wife of a village chief phoned a health activist recently after he'd been to one of George Buannie's meetings and saw a video of a woman giving birth. "What on earth have you done to my husband?" she demanded. "He's a changed man, he's started being nice to me."

So how do you persuade someone like the farmer in Binkolo that it's not a good idea to marry off his daughters at the age of 12 or 13? How can you convince them that when children give birth to children, far too many of them die? "I ask them a question," says Rev. George. "I ask them: 'Which do you prefer? To stand over the corpse of a young girl, as you prepare to bury her body in the ground, or to educate her about sex and contraception, so that she doesn't die?'"

Dr. Jarrie Kabba-Kebbay of UNFPA, the UN Population Fund, one of six United Nations agencies supporting George Buannie's work, has another question for the men of Sierra Leone. At a three-day training workshop for "male advocates and peer educators," with the slogan: "Men taking the lead to put women ahead," she says: "When you go out into the villages and talk to the men, ask them this: 'When you look at your neighbours, who's got the better life? Who's better off? Whose children will have the best opportunities? The man with just two or three children, or the man with 10?'"

It's not a difficult message to get across, says Dr. Kabba-Kebbay. "If a man has fewer children, he can afford to send more of them to school. Girls who go to school are less likely to get married too young, and less likely to get pregnant. And fewer teenage pregnancies mean fewer birth-related deaths."

Sierra Leone should be one of the most prosperous countries in West Africa, with its diamonds, iron ore and bauxite reserves. Yet, the vast majority of its people live in grinding poverty, and the country has the fourth highest maternal mortality rate in the world. About half of all its children suffer from stunted physical or mental development; 70 per cent of its women are illiterate. A 10-year civil war that ended in 2001 destroyed much of the country's infrastructure: there's no functioning national power grid and only a handful of paved roads.

On health, though, it is making progress. With the help of international financial and technical support, the Government has introduced free health care for all pregnant women, nursing mothers and children up to the age of five. A massive training programme is under way for local-level health professionals, supported by H4+.

H4+ is a joint initiative that mobilizes the efforts of six United Nations agencies - UNAIDS, UNFPA, UNICEF, UN Women, WHO and the World Bank - to improve children's and women's health and reduce mortality rates.

Baratu Lee was 12 or 13 when she had her first child. She's not sure how old she is now -- she thinks she's about 27 - and she's had nine more since then. Three children, a pair of twins and a daughter, have died. Baratu is a member of the Fula tribe.

"In my tribe, we love children very much," she says, with her youngest, five-month-old Safiatu, suckling at her breast. "Every time I had a baby, people came to see it. And when they saw that it was healthy, they said I was OK to have another one."

But her neighbours were wrong. When her last baby was born, the doctors told her she would be risking her life if she had any more. And that's where Mabinty Kamara comes in. Mabinty, a community health worker who was trained with the help of the H4+ agencies, had a word with Baratu's husband.

He listened to what she said, he understood, and he agreed. Now Baratu has been sterilised and she says she's so happy that she can concentrate on raising her eight surviving children, including two more sets of twins. Her husband is happy too, she says. A success.

Until recently, Sierra Leone had a mere 100 qualified midwives for the whole country, serving a total population of around six million. Now, thanks to support delivered through H4+, a second midwifery school has opened in the northern town of Makeni.

The students are already qualified nurses, and many have had several years' experience working at the local level. H4+ agencies help sponsor 50 students every year (plus another 50 at another midwifery school in the capital, Freetown), paying all their fees and living expenses. The first group has already graduated and they are back in their local communities, helping to deliver babies safely.

In the village clinic at Masongbo, I meet Zainab Mansaray. She was a nurse for 10 years before training as a midwife, and she's the first one they've ever had at the clinic. Judging by the dozens of women sitting patiently on benches on the verandah, as torrential rain pours down outside, her skills are desperately needed: about a third of the mothers or mothers-to-be look as if they're no more than 15 or 16 years old. According to official figures, one-third of all Sierra Leonean women have become pregnant by the time they reach their 19th birthday, and complications of pregnancy and childbirth are the main causes of death among adolescent girls ages 15 - 19 years old in developing countries.

Dr. Kabba-Kebbay says: "What the extra funding from the H4+ programme has enabled us to do is fill gaps where we were short of resources. That means in particular more trained midwives where they are most needed - it's been a very big success story for us."

In some parts of the country, targets have already been met ahead of time. In Pujehun district, in southern Sierra Leone, not far from the border with Liberia, the district medical officer, Dr. Mohamed Vandi, tells me they've beaten their targets on contraceptive use and "institutional" births (i.e. deliveries in clinics or hospitals rather than in village homes). The training of more health workers in basic maternal and child health care is also being funded through the UN programme -- and in the newly-built maternity wing of the regional hospital, birth-related deaths in the first eight months of 2013 were down to three from eight over the same period in 2012.

"You can actually see the impact of the H4+ programme in so many places," says Dr. Kabba-Kebbay. "More trained midwives, more trained health professionals in local clinics, giving advice on family planning and anti-HIV measures, and now far more births with trained medical staff on hand. Add to all that the work we're doing on educating men about the role they can play, on reducing gender-based violence and on teenage pregnancies, and we really can see the potential for huge changes."

A full set of photos of some of the H4+ programme's work in Sierra Leone, taken by Abbie Trayler-Smith of Panos Pictures, can be seen here.


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