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Reducing maternal and infant deaths in Sierra Leone

Each year 8 million newborns and young children die of preventable causes worldwide and over 350,000 women die in pregnancy or childbirth. In September, the World Health Organization (WHO) published its ‘Global Strategy for Women’s and Children’s Health’, calling on governments, agencies and associations to act and work together to prevent these unacceptable deaths. The report generated real optimism that a significant number of lives could be saved, because it garnered support and commitments from both Western donors and developing countries who are prepared to make major new policy and financial pledges.

This week, the WHO announced the organisation of a group of 25 global leaders (co-chaired by the Prime Minister of Canada and President of Tanzania) tasked with championing the maternal and child health initiatives. This group, who will meet at the World Economic Forum in Davos early next year, will map out how the promises made in the report will be turned into action in the poorest countries.

If the group’s task seems daunting, the leaders might look for inspiration to Sierra Leone, which has one of the lowest childbirth survival rates in the world. In 2009, Amnesty International published a damning report about the “human rights emergency” in the country, where 1 in 8 mothers die in pregnancy or childbirth. However, in April this year, to mark Independence Day, the government of Sierra Leone announced the introduction of free healthcare for all pregnant and breastfeeding mothers and children under five.

The United Nations Children’s Agency (UNICEF) has provided technical and logistical support to aid the government in this important new initiative and the UK’s Department for International Development (DFID) offered extra funding for the health system. Smaller charities have also been providing support for the policy. For example Life for African Mothers, has given medical supplies to Sierra Leone’s hospitals which help prevent deaths from post-partum haemorrhages (PPH) and eclampsia (pregnancy-induced high blood pressure).

Already, after only five months, results from the new initiative in Sierra Leone can be seen. In the three years prior to the introduction of free healthcare, Freetown’s main maternity hospital delivered an average of 1,500 women per year in a city of more than one million people. During the first nine months of this year, more than 3,600 women have come to the capital’s hospital to give birth. And despite the huge rise in numbers, maternal deaths are the lowest recorded in the last three years (at 106 women). Another hospital in Sierra Leone has reported only 3 deaths from PPH and another has had no women die during 2010. The government’s Ministry of Health is confident that as more data is collected, records will show a marked decrease in maternal and infant mortality deaths across the country.

The Millennium Development Goals (MDG) have put forward targets that in five years time there should be a reduction in under-five mortality of two-thirds and a three-quarters reduction in maternal mortality and universal access to reproductive health. This would mean saving the lives of 4 million children and around 190,000 women in 2015 alone. But if Sierra Leone, a country newly emerging from a long civil war, can reduce deaths in the space of five months, the MDG targets may be achievable after all.

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