Latest figures from the 2013 Sierra Leone Demographic and Health Survey demonstrate a greater uptake of certain reproductive, maternal, newborn and child health (RMNCH) services. For example, the percentage of births that took place in a health facility more than doubled since the last Demographic and Health Survey in 2008 (from 24.6% to 54.4% of live births).These achievements reflect, in part, the introduction of the Free Health Care policy by the Government of Sierra Leone in 2010. Despite these achievements, Sierra Leone still faces one of the highest levels of maternal and newborn mortality in the world. Every year in Sierra Leone, an estimated 9,000 newborns die and 2400 women die from pregnancy related causes and childbirth. That is seven women every day and one newborn every hour (see more information in Box 1).These mortality figures indicate that quality of care is a priority for Sierra Leone if both the supply and demand sides of services are to be maintained.
The EVD outbreak threatens to undermine recent progress and further compound areas where little improvement has been made. As of the 1 November 2014, Sierra Leone confirmed 3,936 cases of EVD and 1,070 deaths. With a case fatality rate estimated to be at least 70%, the future death toll is worrying.A recent survey conducted across the country in August 2014 found that whilst there were positive attitudes among the public about prevention of EVD and reported positive behaviour changes, serious misconceptions about Ebola persist. For example, a third of respondents believed that Ebola was air-borne and one out of every five people believed that Ebola can be cured by traditional healers.
These and other misconceptions contribute to high levels of stigma and discrimination towards Ebola survivors and victims, and to how women and health providers interact and behave in the provision and uptake of RMNCH services.The EVD outbreak is placing exceptional pressure on Sierra Leone’s already weak healthcare system. Health workers are overstretched with the ever-growing burden of cases and are faced with the fear of becoming infected themselves, or worse, dying from EVD.Furthermore, the pressure of EVD on the healthcare system is resulting in the potential closure of health facilities, such as the Princess Christian Maternity Hospital in Freetown, which is the largest facility providing emergency obstetric and newborn care services in the country. You can already see the impact this is having on the utilisation of RMNCH services. For example, between May and July 2014, the proportion of women who visited public health facilities in Sierra Leone for their fourth antenatal care visit dropped by 18%* (see more in the graph below).
What’s more, women have a greater susceptability to infection and death compared to men. In the 2000-2001 Uganda outbreak the proportion of Ebola cases was higher among women than men at all age-groups except 0-9 year olds. This is because women are more likely to care for the sick and to prepare deceased bodies for burial. Therefore, without the continued provision of quality RMNCH services, women will be in fear of death from both EVD and childbirth.The next steps that the Government of Sierra Leone and their partners take will be crucial to saving the lives of those most vulnerable during this EVB outbreak: women, their newborns and children. Maintaining the provision of RMNCH services will be vital in mitigating the impact of Ebola in Sierra Leone, and it is thus important that the strategy taken in providing these services is informed by evidence.
Box 1: Maternal and newborn mortality in Sierra Leone:
- A woman in Sierra Leone has a 1 in 21 lifetime risk of dying from a maternal cause.
- The maternal mortality ratio is an estimated 1100 maternal deaths per 100,000 live births.
- Every year, an estimated 2400 women die in Sierra Leone from pregnancy related causes and childbirth. That is seven women every day.
- The newborn mortality rate is an estimated 44 deaths per 1,000 live births.
- Every year, an estimated 9,000 newborns die in Sierra Leone. That is one newborn every hour.
Sources:World Health Organization, UNICEF, UNFPA, The World Bank & the United Nations Population Division. (2014).UNICEF, World Health Organization, The World Bank, & United Nations Population Division. (2014).*DPI. (2014).Trends in the utilization of services in PHUs. Powerpoint presentation presented by the Directorate of Policy Planning and Information, Ministry of Health and Sanitation [Sierra Leone]. Available on request.
