| Abstract: | Barely 50% of births in Sierra Leone are attended by trained medical personnel, and an even smaller proportion of prospective mothers receive antenatal care. This absence of obstetric, antenatal, and postnatal services in many areas of the country makes motherhood in the country far from safe. The maternal mortality rate in many parts of Sierra Leone is estimated to be as high as 8.5 deaths per 1000 live births, or to constitute an almost one in eighteen lifetime risk of death from pregnancy-related causes. Infant mortality is currently 148 deaths per 1000 live births and of those children surviving beyond infancy, a further 200 die before reaching five years old. Marie Stopes International (MSI) has been working in Sierra Leone since 1986 through its local partner nongovernmental organization (NGO), the Marie Stopes Society, Sierra Leone (MSSSL), building a network of five clinic centers across the country. MSSSL has found that a complex set of cultural and social beliefs form a major obstacle to the treatment of obstetric emergencies in Sierra Leone. For example, the local definition of pregnancy complications may not include labor lasting as long as 48 hours. When complications are recognized, their cause is often defined as natural instead of medical. These and other factors like the lack of transport and inadequacy of resources in many facilities result in significant delays in the provision of emergency obstetric services. MSSSL trains traditional birth attendants to understand these issues and recognize complications when they develop, referring women for effective treatment when appropriate. The organization has also initiated a variety of community outreach projects to influence the status of modern obstetric care, including male awareness programs with family planning counseling and services. The MSSSL experience demonstrates how effectively an NGO can work within the framework of a national safe motherhood initiative. |
