Saving Mothers' Lives in Sierra Leone and Liberia

When Zainab first experienced abdominal pain, she was not aware of her pregnancy. It was only after a BRAC community health promoter (CHP), on a routine visit, handed her a referral slip for a local health center, did Zainab learn: she was having a baby.   

At 20 years old, like many women and adolescent girls living in the poor communities of Freetown, Sierra Leone, Zainab was not ready for her first pregnancy. As the jarring statistics show, Sierra Leone is one of the most unsafe countries for a mother to deliver her baby: 1,360 mothers die for every 100,000 births.

Zainab had never learned to prepare for the unfamiliar signs of pregnancy that she would develop. The sheer lack of resources for low-income women and girls, especially young mothers like Zainab, is one of the many factors that contributes to the high rate of maternal deaths in Sierra Leone.  

Thanks to the support of donors like you, BRAC works to ensure that Zainab and other women like her do not join those statistics. With the referral slip from BRAC in hand, Zainab visited the health facility.

For the first time, she could openly discuss her pregnancy with trained health workers and receive professional advice on how to have a safe delivery. Zainab was given appropriate medication to alleviate her abdominal pain, and she learned that she should eat more nutritious food and avoid physically hurting herself.  

Zainab began visiting the health facility regularly; the staunch support from the BRAC health workers helped her become more confident as her delivery day approached. She also made several important decisions: that she wanted to give birth at the health center, that she would breastfeed, and that she would immunize her baby.

During this time, in collaboration with partners, BRAC also reached more than a thousand youths across ten poor communities in Freetown, as a key implementer of “Pull Slum Pan Pipul,” a program that educates girls and young women about sexual and reproductive health, and equips them with other vocational skills that support sustainable livelihoods.

Zainab didn’t pass up the opportunity.

She joined other community members at the health meetings to continue to learn about sexual and reproductive health. The program’s vocational training also equipped her with specialized skills, including how to prepare specialized ingredients as a chef.

Her newfound knowledge inspired Zainab. After her baby is born, she says she wants to open her own restaurant.

“I will become a successful business woman,” she said.

In Liberia, approximately one out of 138 women dies from pregnancy and childbirth. In Sierra Leone, it’s almost twice as high. Rates of maternal mortality in Liberia and Sierra Leone are among the highest in the world. In an age when we know how to prevent these deaths, it is unimaginable to confront this reality.

When BRAC started its prenatal care program in West Africa three years ago, we wanted to change this reality. We understood that while the direct causes of these deaths are severe bleeding, infections, high blood pressure, and complications from delivery, the root causes are more complicated than medical conditions. They are closely linked with poverty and a lack of quality healthcare.

Most women from low-income, rural communities are more vulnerable to pregnancy-related risks for a variety of reasons, some of which include a lack of knowledge about safe health practices, access to health care clinics, unsanitary birthing conditions, and teenage or early pregnancies.

BRAC saves mothers’ lives at the community level. Instead of importing health workers from abroad, BRAC carefully recruits women from within these communities and intensively trains them with professional health care skills. Going from door to door every month to not only provide basic health services but also encourage healthy behaviors, more than 400 community health promoters (CHPs) have reached about 700,000 people across Sierra Leone since the project began.

CHPs are daring agents of change who have both knowledge of disease symptoms and health care treatment, in addition to a unique cultural awareness. They advise pregnant women with daily pregnancy tips, like avoiding heavy work, resting properly, and eating nutritional food. They also connect health clinics with underserved communities that may not know about or distrust the clinics. Thanks to CHPs, pregnant women “are now coming to the clinic in huge numbers for medical counseling and safe delivery,” says Hassanatu, a nurse at one of the health facilities in Sierra Leone.

Women who receive counseling from CHPs also report feeling more confident and informed during their pregnancy. Musu, a 29-year-old Liberian, was anxious about being pregnant for the first time. Howa, a CHP, visited her regularly, easing her concern and sharing some of the symptoms to watch out for when pregnant. When Musu’s feet became swollen, Howa encouraged her to visit a public health clinic. Since then, her health has improved, and she has returned to the clinic for regular check-ups.

BRAC believes in the value of smart public health communication. Too often, development programs arrive in communities with good intentions, but don’t  communicate in a manner relevant or appropriate to those who need it most. BRAC bridges this divide by organizing community meetings, household visits, street theatre events and radio advertisements. It uses these methods to spread awareness about reproductive health, pregnancy-related care, general nutrition, and good hygiene practices in a fun, engaging, and culturally-relevant way.

However, any life-changing program will face serious challenges by default. Before the outbreak ended in 2016, the Ebola crisis in West Africa affected more than 24,700 people and claimed the lives of more than 8,700 people in Liberia and Sierra Leone, countries already faced with a lack of health facilities and trained health workers. BRAC staff on the ground responded quickly, and CHPs distributed thousands of hygiene and sanitation materials and facilitated Ebola prevention trainings, all thanks to your support.

More than 300,000 women die each year because of pregnancy-related complications. Perhaps the only thing more outrageous than this statistic is that the pain and grief experienced by these women and their heartbroken families is preventable.

Let’s work together to continue saving moms’ lives.