Giving birth in Sierra Leone


“Push… PUSH the baby!” Mamie Mattia alternately squeals and whimpers, her left hand wrapped tightly around the window bars, as midwife Christiana cajoles the 22 year old through the final stages of labor. “There is poor maternal effort,” Christiana comments in a stern voice, though she acknowledges Mamie is probably weak from lack of food.

Mamie Morray


Twenty miles away in the village of Tikonko, Mamie Morray shelters from the rain and patiently shells a small mountain of groundnuts. Her age is unclear (although she estimates she’s around 90) and she has nine children.


The actual medical causes of death amongst Sierra Leone’s pregnant women and young children are not much different than in most sub-Saharan countries. But explaining why so many women and babies die in Sierra Leone is much more complicated… and not so easy to wrap up in a social-media-friendly package. Cultural tradition, high rates of teenage pregnancy, lack of education, distrust of an overburdened health system, and extreme poverty make a very potent mix. The legacy of a ferocious Ebola outbreak in 2014 doesn’t make it any easier.


The idea of a silver bullet is an attractive one, but few complicated problems have a simple solution. Strengthening the health system and encouraging more women to use it are obvious answers. High in the densely populated hills of Freetown, tireless community worker Abu Touray leads an army of volunteers who go door to door persuading women and their families to use the local health facilities. “Sometimes people put it down to God’s will. I tell them it is not God — this child is not supposed to die.”

Community leader, Abu Touray, with his granddaughter
A verbal autopsy in Susan’s Bay slum, Freetown


Meanwhile, back in Bo, midwife Christina calmly says the words, “cord around the neck.” Newly trained community volunteer (and former traditional birth attendant) Zainab Sandy hands her a forceps and then scissors. Deftly the midwife unwraps the umbilical cord and, with one final heave from Mom, Sierra Leone’s newest little citizen emerges — alive and well. Mamie was visited during her pregnancy by a volunteer, who encouraged her to attend the ante-natal clinic and come to the health post when her child was due. As yet unnamed, this little boy will face a lot of challenges to his future survival, but one simple decision by his Mom has at least given him a fighting chance.

Mamie nurses her newborn baby boy