Sierra Leone has one of the highest maternal death rates in the world. Research and observation by Amnesty International reveals that reasons for the hauntingly high number of deaths include lack of adequate and reputable healthcare centers, lack of trained doctors, shortage of medicine and supplies, lack of structure in all medical systems, lack of transportation, lack of education, and lack of money. The lack of money plays a major role in families’ decisions not to seek professional medical help as soon as a problem occurs. The report repeatedly mentions examples where the family waits until death is mere hours away before approaching the obstacles of transportation and hospital fees.
The health system in Sierra Leone is not regularized, which allows medical attendants to charge whatever price they feel like and often refuse lifesaving treatment until they have been paid. Because attendants are often not paid a salary – or if they are it is often a sum not worth counting – the only way attendants can make a living is by charging those seeking medical help large bills. Whole communities are known to come together to help pay the tab, further impoverishing the family and community. The situation only worsens by the observation that even when the money is gathered and transportation is finally secured, there often is not a doctor present or adequate resources available to help the mother. But there is a problem more fundamental and ultimately deadly for women in Sierra Leone. This insidious issue manifests itself in many of the interviews conducted among families that have experienced maternal deaths. It is common in these interviews for the man – the decision maker in the patriarchal society of Sierra Leone – to mention that he simply did not feel he had the money to take the wife to the hospital. So he didn’t. Or the fees were too high to keep her at the hospital. So he just took her back home. Or transportation was too hard to locate. So he didn’t bother. Or the hospital would charge him an extra fee to take care of her body if she died there. So he brought her home to die for free.
Beyond the failings of the government to supply adequate health care for mothers in need is the damage being done within families and communities regarding the lives of mothers. A price has been put on the lives of these mothers who are suffering and in need of medical attention – a price that is sickeningly often considered far too high to actually be paid. And so the number of maternal deaths continues to climb. While it would be heartless to put all the blame on families who desire to help the mother but are truly impoverished, it would be an injustice to many other women of Sierra Leone to not mention the devastating affect their lack of decision making power and monetary capital is having on their lives. For many of these women, the price, in fact, for lack of power within the family and money is death.
In the report, Amnesty International offers many suggestions and carefully outlines how the government can help fix the broken medical system and thus improve the lives and rights of women. However, they do not address how women can gain ground within the home and be more than a burdenous price as they struggle through a situation they clearly did not put themselves in alone. Pregnancy takes two and the choices regarding the lives of those involved should be considered by two as well. I supply my own solution that education is key to creating change at the foundation. As women in Sierra Leone become educated, on health, family planning, science, literature, math, etc., they will be better equipped to be a force within the home and community. The positive externalities of such education have potential to decrease the maternal death rate, which the report firmly advocates is a problem that is completely capable of being solved. An educated populace should reflect that life is so much more than a monetary inconvenience, in Sierra Leone and throughout the rest of the world.
Information from the Out of Reach: The Cost of Maternal Health in Sierra Leone report by Amnesty International.