Sierra Leone is an African state that is portion of the developing states of the universe. It is made up of 20 cultural groups. Among them are the Creole ( Krio ) group of which 10 % are posterities of freed Jamaican slaves, ( Quindex mundi Profile, 2010 ) . In their July 2009 estimates a population of more than five million, with a decease rate as 22.22 deceases /1,000. In footings of gender specific maternal mortality rate it is estimated to be 1 in 9 births, ( UNICEF ) , motivating Amnesty International to nickname it “ a human rights exigency. ” This means that for every nine female parents who give birth in Sierra Leone, one is expected to decease, specifying its Maternal mortality rate as reeling compared to the remainder of the universe and even some other developing states, ( UNICEF ) . The ICD 2007 of the World Health Organisation ( WHO ) defines maternal decease is any decease of a female parent during gestation and up to 42 yearss after birth. This province of personal businesss in Sierra Leone is of peculiar importance when examined against the Millennium Development Goals of bettering maternal wellness by 2015.
Like every state of the universe, Sierra Leone has been concern with achieving the stipulated ends of the Millennium by 2015, but seems non to be able to accomplish it. This has chiefly to make with the fact that they are a underdeveloped state and as such are plagued with the same sort of challenges that the remainder of the developing states faces. The 5th MDG calls for the decrease of maternal mortality by 75 % 2015. It is thought, that critical to achieving this end is optimal direction of pregnant adult females during labor, ( Ronsmans, Elahi Chowdhury, Koblinskyc & A ; Ahmedb, 2010 ) . They further advised that this can merely be achieved by using skilled medical suppliers, particularly during the labour procedure and for the first 24 hours thenceforth.
WHO estimates, that in surplus of 528,000 adult females die annually due to complications environing kid bearing and gestation. A figure of obstetric conditions have been named as the common causes. They include ; sepsis, obstructed labor, bleeding, eclampsia, complications of abortion and ruptured wombs. They go on to describe that cumulatively, bleeding is the cause of more than half the maternal deceases in sub-Saharan Africa accounting for more than one-third obstetric deceases worldwide. In Sierra Leone, bleeding was so a major cause, the primary predisposing factor being the culturally ineluctable pattern of venereal mutilation, where it was reported that 90 % of the adult females in Sierral Leone have some signifier of Female Genital Mutilation ( FGM ) , ( Bitong 2005 ) . The ensuing cicatrix, particularly from the more invasive signifier of FGM, infibulation, significantly compromises the birth canal, frequently bring forthing cryings in the walls of the vagina and besides increasing the usage of episiotomy, surgical scratch into the walls of the vagina, in order to ease birth. Both processes predisposes to post-partum bleeding and decease, particularly in the absence of trained medical forces, as is most frequently the instance in Sierra Leone.
In 1980s, a chief end of primary attention in Sierra Leone was to accomplish the decrease of maternal mortality to 30 % of the present statistic, ( Konteh World Health Forum, 1998 ) . They hoped to hold accomplished this by the stopping point of the century. Konteh notes that the mark was non reached and gives a figure of grounds for its failure. One of the grounds, he postulates was that intercession techniques employed, were non specific for the population. The “ Human Services Practitioner ” Systemic codification ( 2008 ) , stipulates that any intercession aimed at a population must be done with thorough cognition of the population to be served and technics specially to run into the demand of that population. The absence of that cultural specificity has been identified as the ground why many of the pregnant adult females refrained from utilizing the services that were made available. Even so, when some of the adult females attempted to utilize the clinics, they were met with really aggressive and unfriendly nurses and other wellness attention forces, ( Konteh, 1998 ) . He besides noted that there was a really hapless prenatal history since most of the adult females refused to go to the prenatal clinics allow entirely the postpartum 1s. For this ground a female parent ‘s child birth history was mostly unknown and as such wellness attention professionals were unable to make put on the line stratification programs to efficaciously cover with any at hand complications. Notwithstanding, many bringings happened in places. In 1996, “ about 69.5 % of bringings in the anterior 24 months occurred at place, 21.5 % were performed at a wellness Centre, and about 9 % occurred in the infirmary, ” ( Konteh, 1997 ) . He cites that this was due chiefly to the fact that distant countries were normally non reached by maternal wellness Plutos. Those countries were preponderantly served by, traditional accoucheuses called “ traditional parturition helpers ” . Further to that, Konteh notes, these birth helpers were non good perceived among the wellness suppliers because their supplies, instruments and tools were unsterile and often the cause of infection frequently with fatal results.
The Southern Cross of the affair is that Sierra Leone sees less than 50 % of its birth done by medical forces that are trained in labor, and even a smaller proportion of pregnant adult females of all time attend prenatal clinics, ( Wachuku, 1994 ) . The inevitable rise in mortality rate has led to international administrations like the Marie Stopes International ( MSI ) to get down work in Sierra Leone in an effort to extenuate the impact of the lifting maternal mortality rate in that state. Through its local non-governmental spouse, the “ Marie Stopes Society, Sierra Leone ” ( MSSSL ) , this administration in 1986 was involved in constructing five clinic across Sierra Leone. During their discourse what they found as another major cause of the blue maternal mortality rate had to make with beliefs that were steeped in societal and civilization patterns like venereal mutilation, authenticating the earlier study by the WHO, that venereal mutilation was holding important effect for the wellness of the female parent in childbearing. Those societal and cultural issues were considered to be a major obstruction to the effectual direction of labour exigencies. One illustration is the belief that labour enduring for more than 48 hours are non considered a complication of gestation, ( Wachuku, 1994 ) . In western medical specialty this is termed drawn-out labor and has built-in complications like obstructed labor, uterine rupture and bleeding, ( Collins, Arulkumaran, Hayes, Jackson & A ; Impey, 2008 ) . This is confounded by the belief that when complication occurs, it is frequently defined as a natural cause and non considered to be of an obstetric/medical beginning. The MSSSL further found that transit and deficiency of resources in the Centres impedes the bringing of exigency services when the demand arises.
Konteh, ( 1997 ) composing in the community development diary, cites a figure of socioeconomic identifiers together with some wellness variables impacting maternal mortality rates in 12 chiefdoms in Sierra Leone. He foremost indicates that early matrimony was straight related to the high para, and went on to describe that more than 40 per centum ( 40 % ) of the married adult females did so by the clip they were 15 old ages old. He besides recorded that in the age group of 45- 90, approximately 85 % of them had six or more kids. He found the highest para of more than nine kids among 55.1 % of the adult females population, with even higher birthrate in some localized countries. Then effect of increased para include placenta previa, arrangement of the placenta excessively near to the neck, placenta abroptio, shed blooding between the placenta and the womb and hasty labor, highly fast labor, all of which increases the hazard of post-partum bleeding, ( Oxford Handbook of Obstetric and Gynaecology 2009 ) . This is go oning against the back bead that the bulk of adult females have ne’er received primary instruction, a critical determiner of wellness, ( WHO, 2010 ) . Equally far as business is concerned 80 % -90 % of the population in the countries studied by ( Kendeh 1997 ) , were subsistence husbandmans who are hapless, another of import determiner of wellness as defined by the WHO.
This is non so state that the authorities did non recognize and was non concerned with the rate at which maternal deceases were go oning. ( Kendeh, 1997 ) noted that the authorities recognised the demand to set in topographic point plans to extenuate the increasing mortality rate among pregnant and post-partum adult females. He found that the Government embarked upon developing community incentives to be competent in community instruction and formation of small town action groups, which was to ease emergent conveyance of adult females in labor who develop complications. In 1993 -1994 some betterment was seen but the Numberss rapidly dropped due to terrible break in service caused by civil discord, ( Kendeh et al. 1997 ) . From 1991, there has been old ages of political instability in Sierra Leone from the “ Revolutionary United Front ” ( RUT ) who overthrew the Government and was merely able to return to democratic regulation boulder clay 1998, ( Global security, 2005 ) . This did non give the authorities adequate clip to see the program that began bettering the maternal decease state of affairs come to fruition.
Absorbing the foregoing information still begs some inquiries. What so is ground for the high maternal mortality rate in Sierra Leone, particularly since the chief cause of maternal mortality rate is non alone to Sierra Leone? What sets them apart from the other developing states that pattern FGM and have high incidence of post-partum bleeding? The reply lies in the apprehension that foremost, non merely does Sierra Leone pattern FGM, but they pattern the most extremist signifier of it, infibulation. Infibulation, classified as type III, involves the entire deletion of the external genital organ and the partial sewing of the vagina, go forthing merely a little mercantile establishment for menses ( Bitong, 2005 ) . It is the most utmost signifier of FGM and ninety four per centum 94 % of adult females in Sierra Leone are subjected to this signifier of FGM. This is go oning against the background that this pattern, while with a prevalence rate of 90 % , prevalence is highest in the rural countries that have really small trained wellness attention forces or health care installations, and where most of the births are still done by the traditional birth helpers. As a consequence, though bleeding is the common cause of maternal mortality, in Sierra Leone, it more likely than non, to ensue in decease for the female parent.
It is instead unfortunate that the blue maternal mortality rate in Sierra Leone will non demo important betterment, 0.1 % as stipulated by the WHO. One implicit in ground for the deficiency of betterment is the trouble that authorities faces to supply entree to wellness service and equip installations in distant countries. This is compounded by the job of FGM, which is so culturally deep-rooted, that attempts to turn to it hold been met with violent opposition. This means that to efficaciously pull off this unstable place, a paradigm displacement will hold to happen as it relates to gender mutilation, para, apprehension of what constitutes an obstetric exigency, handiness of trained wellness assistance with civilization sensitive attitudes and general betterments in entree to wellness attention. Obviously this will demand a many-sided attack by many stakeholders to stem the tide, every bit good as an injection of foreign assistance to assist run into the costs. This is the repeating quandary in so many developing states, so much to make with so small resources, a state of affairs that is confounded by political instability. Public wellness professionals will hold to go on to make what they have ever done – research, enlighten, give way and merely wait to see if the guidelines are heeded. Meanwhile, the hapless and vulnerable die day-to-day.