Sierra Leone is the worst place in the world to have a baby. One reason for that is medical fees, which stop women using clinics. But this 20-year-old policy imposed by aid donors on poor countries is finally being challengedby Alex Renton / March 22, 2010 / Leave a comment
Published in April 2010 issue of Prospect Magazine
Mabinti Brima (right) with two of her children and a grandchild. Mabinti’s daughter Sia died while five months pregnant
Mabinti Brima’s home is a two-room shack sheathed in rusty corrugated iron. She shares it with 11 members of her family: daughters, their husbands, grandchildren. None have any formal work. Mabinti makes a living by selling cooked chicken offal in the alleys snaking along the hillsides of Dwarzak Farm, one of the biggest slums in Freetown, capital of Sierra Leone.
The shack stinks and it seems improbable that 11 people live there. But now there is one less person to fit. A few days before my visit, Sia Brima, Mabinti’s eldest daughter, collapsed after three days complaining of “pains in her bones.” An ambulance was called but Sia died before it arrived. She was 24, engaged to be married and five months pregnant.
Like her mother, Sia suffered from sickle-cell anaemia. Even in the developed world, 20 per cent of babies born to mothers with this disease will be premature or underweight and there are serious risks of miscarriage. But no one knows what killed Sia. Her body was buried the same day, without an autopsy. The death certificate recorded “sore bones.”
It was just another death in an African slum, in a country where one in eight women die from complications in pregnancy and childbirth. Yet Sia’s death, like the majority of those occurring to pregnant women in Africa, was avoidable.
Sia had no antenatal care. On the first day of her pains, she went to see a “private doctor.” He sold her folic acid pills and advised her to go to the state-run Princess Christian Maternity Hospital. But Sia couldn’t afford it. A consultation at the hospital is at least 5,000 leones (85p), and treatment much more. This is well beyond the means of the average Sierra Leonean, 70 per cent of whom live on less than $1 a day.
Sia lived ten minutes’ walk from a health clinic—but she couldn’t afford to go there either. The George Brook clinic was built by Unicef and is run by the government and NGOs. A first visit costs 25,000 leones (£4.20). Women who don’t pay may be detained until their family coughs up. It would take Mabinti two weeks to earn 25,000 leones. “But I would have done it,” she told me. “I would have done anything. Sia was my eldest, my helper. She was a pillar of this family.”