On its web page titled U.S. Relations with Sierra Leone, the State Department gushes with warmth and affection for the African country—once called “the ‘Province of Freedom’—which remains among the world’s poorest countries, ranked 180th out of 187 countries in the Human Development Index in 2011.
This embrace by the richest nation in the world of one of the poorest cannot hide the sad fact that the West African nation’s rockbottom spending on health—at $46 per person yearly—is among the lowest in the world. In 2018, government expenditure on health per capita for Sierra Leone was US $8.
Inadequate spending and funds lost to corruption pose the greatest threat to women, according to the United Nations. One in 20 women in Sierra Leone die as a result of pregnancy or childbirth, most often from losing blood. The West African country consistently ranks as one of the deadliest places on Earth to have a baby. Only South Sudan and Chad count higher mortality rates.
A Transparency International survey in 2015 reported an astonishing 84% of Sierra Leoneans had paid a bribe for government services, according to a Gates Foundation thinktank based in Senegal.
A country of 8.3 million, Sierra Leone remains at the extreme end of a regional trend. Sub-Saharan Africa accounts for 66% of all maternal deaths in the world. Researchers point to the fact that fewer women give birth in a health facility in West and Central Africa than anywhere else, at 60%, well below the global average of 83%.
Showing up doesn’t always mean getting help: Sierra Leone has reported a persistent dearth of health workers, and access to blood is widely unreliable. Abortion is illegal and frequently performed without medical supervision. Health officials estimate that unsafe abortions cause between three and four percent of the nation’s maternal deaths.
Because cost was one of the top obstacles deterring pregnant women from medical professionals, the country removed fees for their doctor visits and drugs under the Free Health Care Initiative.
The new program drove major progress. The share of women giving birth at a health facility in Sierra Leone jumped from 25% in 2008 to 54% in 2013 to 83% in 2019, national statistics show.
Then came the pandemic. Foreign aid worldwide shifted from old emergencies to new. Britain, the key backer of Free Health Care for years, told Sierra Leone’s Health Ministry the support had to end.
“Whenever we cannot give a pregnant woman what she needs, it’s a tragedy,” said Isata Dumbuya, at Partners in Health in Sierra Leone.
“There are lucky weeks. There are lucky months,” said Frances Wurie-Sesay, an obstetrician at the King Harmon Maternity and Child Health Hospital in the capital, Freetown. “And there are times when the only free thing I can offer a patient is a consultation.”
“There is never a guarantee that we will have the blood to save a life.”