Perils of Pregnancy: Fighting for Life in Sierra Leone

The Magburaka Maternal and Child Health Clinic, photo courtesy of The Sierra Leone Ministry of Health and Sanitation

Healthcare in Sierra Leone, West Africa, a country of almost 5 million people, has always been dreadful as far as I can remember growing up in Freetown, the capital city.  The Time magazine, June 14, 2010, story of Mamma Sessay titled The Perils of Pregnancy: One Woman’s Tale of Dying to Give Birth by Alice Park reminds me of some of the painful cases of maternal mortality, which has growingly worsened in this African nation.  A co-worker, Meagan Manas of Women’s Ministries at the National Council of Churches (NCC) approached me to respond to Mamma’s story, which shows graphic images of this fourteen-year old, who hemorrhaged to death while giving birth.  In watching the photo gallery, I was angry, yet, relieved to know that maternal mortality and the issues of cultural beliefs and family pressure, teen pregnancies, survival, patient care, access to resources, fistula, and sometimes death are common and critical concerns for support and discussions, especially in communities of faith.

Sierra Leone is not only historically known for the Trans-Atlantic Slave Trade during the 17^th and 18^th centuries and the horrible Civil War (from 1989 – 2001) that claimed the lives of hundreds of thousands and left tens-of-thousands mutilated and shelter-less, but also ranks as one of the world’s poorest nations.  This ranking has lasted for over forty years and is far from ending, which also reflects on the country’s healthcare system.  Such is the story of Mamma, a common occurrence then and now.

From the photos we learned Mamma’s family forced her to marry at age fourteen.  This custom of forcing young girls to marry early and to bear children is deeply embedded in most African cultures and needs eradicating.  Education regarding abstinence and prevention will greatly help keep young people safe from sexually transmitted diseases, and, at worst, death.  Nonetheless, by age fifteen, Mamma had her first child and three years later, she was pregnant with twins.  According to Park, Mamma was accompanied to the Magburaka Government Hospital by her older sister.  They traveled by a canoe and an ambulance to see the only district doctor, who took almost a half hour to see her.  Mamma was even luckier than many women in labor who sometimes have to bribe officials or are abandoned at the hospital because they cannot afford the fees.  Park further states that Mamma’s twins were 24 hours apart because contractions had ceased by the time the second twin came.  Mamma’s vital signs and situation worsened.  In most cases, there is usually no blood transfusion or the proper technology.  As a result, Mamma painfully bled to death as she repeatedly screamed “I’m going to die.”  Mamma’s mother, Marie Yatteh who herself is a young woman was breastfeeding her child when a nurse broke the sad news.  She unbearably collapsed to the ground as other family members shockingly looked on.  She now has to care for the twins.  As Park writes, “In Sierra Leone, 1,033 women die for every 100,000 live births, one of the world’s highest rates of maternal mortality” a phenomenon that is “almost always preventable.” Mamma’s experience brought a few cases to mind.

Upon arrival in New York City in my teen years, I could recall from letters and phone calls the stories of four closest teenage friends.  We grew up on the same street along with several other schoolmates.  They all died while giving birth.  The sweet memories of playing, cooking, sharing lunch, braiding hair and so forth are still fresh in my mind.  Yet, the bitter pain of knowing that African women are progressively dying from childbirths and suffering from fistula,  resulting from poor economic and sanitary conditions, lack of education and information, inaccessibility to doctors and nurses as well as sub-standard medical care still frustrates me.  I asked myself, where is God in the midst of these events in life?

In 1996, I was in Freetown doing doctoral research on the African tradition known as the Naming Ceremony. After only one month of tracking women who were about to deliver at the main maternity hospital (at the time, one of two) in Freetown, I stopped visiting the hospital.  Frequently only the mother or the baby survived, or both died.  I was horrified–not to mention the filthiness around the only open grayish surgical ward that was neglected and ill-equipped.  In most cases, delivering mothers had to provide their own beds, linens, medications, and at most times, their own food.  But, most importantly, some of these women carried along with them their Bibles, Korans, and other objects which they clutched onto and even kept under their pillows for reassurance and hope from God.  I watched women with very strong faith face such hardship, and despite all their prayers some of these women still died.  The end result was that I rerouted my visit from the hospital only to find new mothers in their homes.

Traditionally, women gave birth in their homes or in huts outside their homes and were usually attended by midwives or elder female relatives.  During these times, families and their communities evoked the spirits of gods and likewise used forms of cultural herbs to protect both the mother and the unborn child from conception, through birth to the end of life.  Today, it seems as though birthing at home and all the religious beliefs as well as ritual practices around it are becoming the trend in Sierra Leone as maternal mortality increases in both hospitals and small makeshift clinics.  This alarming death rate not only happens in Sierra Leone but also across Africa and elsewhere is raising some serious concerns in the global community.  From the Time article, it is clear that the situation of maternal health and survival, including the condition of fistula, is one that is reversible as some pregnant women and the mothers of newborns receive treatments within weeks or months through organizations including Doctors Without Borders (DWB), the United Nations Population Fund (UNFPA), and Mercy Ships, just to name a few.

In conclusion, the need for health education pertaining to pregnancy, childbirth, mortality as well as prevention, treatment, advocacy, and empowerment in the lives of Africans–in particular Sierra Leoneans–especially in this post-war era is of utmost need.  Sierra Leoneans in the diaspora, specifically in New York City, are slowly addressing this issue in their groups such as the Sierra Leonean Nurses’ Associations (SLNA) and the Sierra Leone United Women’s Association (SLUWA).  Likewise, there are various international organizations, NGOs and individuals who are lending their voices and providing services.  It is my belief that change can only come to Sierra Leone and the world when like-minded people come together for this dying cause.  People of faith can actively engage in prayers, education, dissemination of information, fundraising, and partnering with local Sierra Leonean NGOs at home and in the diaspora to end the sorrows and embrace the joys of life.

Elizabeth Claudia During, PhD
Socio-Cultural Anthropologist