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 These women are preparing to give birth in a country estimated to
have the world's highest rate of maternal deaths. More than one in
100 women in the West African nation die during childbirth,
according to the World Health Organization (WHO).
"My niece died during childbirth a few years ago," Powells, 34, said
during a break at the Princess Christian Maternity Hospital (PCMH)
in the capital of Freetown.
"I wasn't there to assist her, to save her," she said, sweat
dripping down her faded lilac scrubs. "Pregnant women must come to
hospital regularly so that they can get the help they need."
Despite a chronic lack of doctors, nurses and midwives and a
tradition of giving birth at home, maternal deaths were on the
decline in Sierra Leone until 2013 - having halved since 1990.
Then Ebola struck. The world's worst outbreak of the virus ravaged
the country's fragile health system, killed a tenth of its doctors
and scared people away from health centers.
Maternal and child deaths spiked as a result, and the country's
maternal mortality rate soared to 1,360 deaths per 100,000 births
last year from 1,100 in 2013, U.N. data shows.
The government and the United Nations say they have learnt lessons
from the Ebola epidemic, which sparked a fresh drive to improve the
health system - on which less than 10 percent of the state budget is
spent - and reduce maternal deaths.
"Ebola was a necessary evil," Margaret Mannah-Macarthy, midwife
adviser for the U.N. Population Fund (UNFPA) told the Thomson
Reuters Foundation. "It was an eye-opener which showed the issues
facing our health system. Now we must tackle them."
Those issues include training more midwives, coaxing doctors back
from abroad, boosting blood donations and ensuring women give birth
in health facilities, health experts say.
MIDWIVES MATTER
Sierra Leone's 1991-2002 civil war drove away many medical
professionals, leaving some 130 doctors to care for a population of
seven million people - one of the world's lowest doctor-to-patient
ratios.
There were also fewer than 100 midwives as of 2010, because, unlike
other African nations, Sierra Leone did not invest in midwifery in
order to combat maternal mortality, the UNFPA said.
The introduction in 2010 of free healthcare for pregnant women was a
major factor in driving down the maternal mortality rate, but it
left midwives overwhelmed, Mannah-Macarthy said.
Yet during the Ebola epidemic, it was not a lack of midwives but
mistrust of health workers that saw maternal deaths soar.
Maternal deaths rose by 30 percent between May 2014 and April 2015
compared with the previous year, as fewer women sought pre-natal
care or gave birth at health centers, a study by the UK-based
Liverpool School of Tropical Medicine showed.
"It is the husbands and relatives of pregnant women who often make
the decisions about their health, which during Ebola meant
delivering at home with a traditional healer," said Husainatu Kane,
chief nursing officer at the health ministry.
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"It is crucial that we regain trust in the health system, and the
important role that midwives play in child birth."
The state aims to boost the number of midwives to some 1,150 in 2020
from around 500, which Kane called a "Herculean task". A second
midwifery school opened in 2010 in the central Makeni region, and
plans are afoot for two more in the east and south.
Preparing for a class in a cluttered room full of training dummies
and baby dolls in the PCMH's National School of Midwifery, principal
Joan Shepard said it was important that midwives were not
concentrated in Freetown.
"If you teach midwifery only in the capital, then students set up a
life here, and may not want to work elsewhere," she said, sifting
through a pile of latex gloves and stethoscopes.
BOOSTING BLOOD BANKS
Besides increasing the number of midwives, the government has
considered other strategies to improve the odds of survival for
pregnant women in a country where 3,000 are estimated to die each
year during or just after giving birth.
An emergency fleet of ambulances and paramedics, improved recording
of maternal deaths, and offering health workers who have left the
country financial incentives to return are all on the agenda,
according to several health ministry officials.
Yet with four in 10 maternal deaths caused by bleeding, appealing
for donations and boosting blood banks is crucial.
"We don't have enough blood in our banks, so you often have to
search for a donor for each pregnant woman in need," said Santigie
Sesay, director of reproductive and child health. "By the time you
find one, the woman will most likely be dead."
Sierra Leone needs a nationwide campaign to raise awareness about
donating blood, and should reach out to communities, schools and
even the military, the health official said.
Despite these difficulties, pregnant women are steadily returning to
health centers for prenatal care and to deliver.
In the postnatal ward of the PCMH, new mother Grace Sellah said she
was anxious about going into labor, having lost her firstborn during
childbirth two years ago.
"I was quite nervous," the 27-year old said, as the days-old baby
boy nestled in her arms stretched and yawned after waking.
"But the nurses and midwives looked after me so well ... it filled
me with the courage to give birth here in hospital."
(Reporting By Kieran Guilbert, Editing by Katie Nguyen.; Please
credit the Thomson Reuters Foundation, the charitable arm of Thomson
Reuters, that covers humanitarian news, women's rights, trafficking,
corruption and climate change. Visit news.trust.org)
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