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Saving Mothers' Lives in Sierra Leone and Liberia

Saving Mothers' Lives in Sierra Leone and Liberia
Saving Mothers' Lives in Sierra Leone and Liberia
Saving Mothers' Lives in Sierra Leone and Liberia
Saving Mothers' Lives in Sierra Leone and Liberia
A mother and her children receive vital healthcare
A mother and her children receive vital healthcare

Of all the public health challenges facing West Africa, malaria may be the most insidious and destructive.

It is  a leading cause of death in the region, with an average of about 150,000 cases of Malaria reported annually in Sierra Leone alone for the past five years.

Malaria disproportionately affects women and children. It causes serious illness in pregnant women and children, who suffer decreased immunity to the disease and, as a result, are twice as likely to contract and die of it. Malaria during pregnancy also causes as many as 10,000 maternal deaths each year and is a leading cause of impaired fetal growth, low birthweight, and infant death in the region.

However, in both Sierra Leone and Liberia, approximately half of all children under five and more than half of pregnant women do not have access to antimalarial drugs.

The issue is exacerbated by cultural practices that further misperceptions about the disease. Many families believe specific food items like oranges and palm oil  cause malaria and depend on traditional remedies for treatment of the disease.

Recognizing that malaria prevention is a critical component of a holistic maternal and child health care program, BRAC includes a focus on empowering communities for a malaria free society. BRAC has established over 660 community health committees and 180 school health clubs that increase awareness on the prevention and treatment of malaria, especially among women, adolescent girls, and children.

These committees and clubs promote three main practices to prevent malaria: sleeping in long-lasting insecticide-treated bed nets, seeking treatment within 24 hours of infection, and taking additional precautions to prevent malaria in pregnant women.

After joining her school’s health club, Josephine, a student in Sierra Leone, now spreads public health knowledge on these issues in her school, family, and broader community.

“I have used my knowledge to create an impact in the lives of my schoolmates and family members at home. We no longer drink [traditional medicine], and everyone now sleeps in the net every night.”

Another women, Hawa, has also felt the impact of these programs. During her past pregnancies, she did not visit a doctor or hospital; instead, she drank traditional medicines to prevent diseases like malaria. Hawa believes that these choices may have contributed to multiple miscarriages she has endured.

When Hawa was five months pregnant with her youngest child, a neighbor who is part of a local malaria committee paid her a visit. She and her husband asked many questions about the disease, including how to prevent it. That day, they learned that malaria is caused by bites from infected mosquitos, and they also learned how to take precautions to prevent and treat the disease.

Hawa credits that visit from a trusted community member as the reason that both she and her baby survived the pregnancy. She has since joined the local malaria club in her community to learn more and help other women and children seek early medical care.

Together with generous donors like you, BRAC has been able to make a major impact on mothers and children in West Africa. Thank you for your continued support.

Preventative malaria programs encourage bednet use
Preventative malaria programs encourage bednet use


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Meet Zainab
Meet Zainab

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.

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Fudie (right), a CHP, educated people about Ebola.
Fudie (right), a CHP, educated people about Ebola.

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.

Musu received pregnancy care from a CHP.
Musu received pregnancy care from a CHP.
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Community meeting in Liberia
Community meeting in Liberia

“It was hard to believe Ebola killed all of my children and husband,” Janet Wee told a group of survivors gathered for a counseling session in Dolo Town, Margibi County in Liberia. “When I was discharged from the ETU, I was totally stigmatized and discriminated against by friends and other community members simply because I am an Ebola survivor.”

Liberia was recently announced Ebola free, but some of its aftershocks – economic instability, stigmatization towards survivors, and lingering health issues like vision problems – are still present in its wake.

BRAC’s community health workers – local female volunteers trained in basic health services – are working with BRAC staff in Liberia and Siera Leone to host educational sessions that address stigmatization of survivors, like Wee, and acts of discrimination by neighbors. Through community gatherings, radio broadcasts, and individual and group counseling sessions, survivors are encouraged to share their stories and experiences with other survivors and community members to foster dialogue while providing psycho-social support.

BRAC has put specific emphasis on supporting orphans, mothers, and adolescent girls who have been left particularly vulnerable after the outbreak. With a noticable increase in teenage pregnancies in both countries, pre and post-natal care is especially important for these young mothers. BRAC has more than 400 community health workers active in Liberia and more than 500 in Sierra Leone who regularly visit pregnant women and new mothers in the community to check their vitals and educate them about nutrition for women and their babies.

With your support and help from new donors, BRAC's psycho-social program will continue in tandem with our maternal health initiatives. Our CHP’s are reaching hundreds of mothers each month providing pre and post-natal care and referring women who have complications to local clinics and hospitals. Thank you for supporting this important work.

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A community health promoter and mother in Liberia
A community health promoter and mother in Liberia

BRAC's child and maternal health programs in Liberia and Sierra Leone are slowly taking stock and starting to rebuild. I spoke today with Ezra Lubemwa, the program manager for BRAC Liberia's health programs based in Monrovia who gave me an update. Due to travel restrictions and bans on public gatherings, the maternal health program was forced to shut down from August until December. The program has started again in earnest, with a 'no touching' policy for Community Health Promoters (CHP's) when they're visiting expectant mothers.

Ezra also mentioned that during the outbreak, CHP's and program assistants played a role in educating their communities about how Ebola was spread and distributed supplies (chlorine, hand sanitizer, plastic gloves, etc.) to those in need.

Now, the program adjusting to the country's changes and looking forward. CHP's are beginning to do follow-up with pregnant mothers they were visiting before the outbreak. Much of their job is often refering mothers and children to local clinics if health challenges arise. A number of clinics were forced to shutdown or were taken over by Ebola patients during the outbreak. To find out which ones are operating, CHP's taking stock of clinics in their communities so they can refer their patients. Many women travel far to get to clinics so this recovery will take some time. That being said, they are playing a key role in educating mothers and children on where they can go if they have health issues, Ebola related or not.

I asked Ezra what role mothers played during the outbreak. He explained that BRAC trained over 100 women to become birth attendants and they all helped mothers have safe deliveries in their communities when clinics were closed.

In February, Ezra explained that the program will restart its community outreach and teenage pregnancy initiatives, incorporating Ebola awareness into both. Public gatherings are still restricted to 7-8 people so the reach will be small at first. He is hopeful that it won't be long before their operations return to normal.

Thank you for supporting the courageous work of these women who are often risking their lives to help mothers and children in their communities.

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Organization Information


Location: New York, NY - USA
Project Leader:
Walid Sghari
Finance Manager
New York, NY United States

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