One in eight women in Sierra Leone risks dying of pregnancy and childbirth complications exacerbated by a combination of poverty, discrimination, inequality and government mismanagement, an Amnesty International report said on Tuesday.
It said there were only 78 doctors for 5.8 million people, health services were distributed inequitably, drugs, medical equipment and supplies were insufficient and there was a poorly equipped and inadequate referral system in the West African state which is still recovering from a decade-long civil war that ended in 2002.
"Hundreds of women meet death on their way to hospital because the clinics are too far away," Irene Khan, Amnesty InternationalÂ?s secretary general, said in an interview with AlertNet.
"In six of the 13 districts of Sierra Leone there is not one single hospital that provides emergency obstetric care. That means if a woman needs a caesarean operation, she will die if she lives in any of those health districts."
The report said the critical delays that increase the risk of maternal death start at home where women have little decision-making power over their reproductive lives.
Given their low status and lack of economic independence, women are rarely able to decide for themselves to go to a healthcare facility, whether for family planning, antenatal care, deliveries or emergency services.
With less than half of deliveries attended by a midwife or similarly skilled person, and less than one in five carried out in a clinic, maternal death is seen to be a part of life.
It is not regarded as something which is preventable and largely avoidable, Khan told AlertNet.
"Men readily accept that their wives or their daughters will die in childbirth and they do not prioritise this issue. They donÂ?t think that this is something that can be stopped and has to be stopped," she said.
The cost of treatment is another barrier to womenÂ?s access to live-saving treatment in a country where 70 percent of the population lives below the United Nations poverty line of $1 per day, according to the report.
The absence of a standard cost for services or transparency about healthcare fees in addition to regular corruption in hospitals frighten most poor families off proper care.
The report - Out of Reach: The Cost of Maternal Health in Sierra Leone - urges the Sierra Leonean government to fully implement the policy it adopted in 2002 to exempt vulnerable groups, including pregnant women and lactating mothers, from paying fees for essential drugs and treatment as well as step up anti-corruption efforts in the health system.
On Wednesday Britain and the World Bank will jointly announce a facility for expanding funds for healthcare in developing countries including Sierra Leone, with particular focus on infant and maternal mortality, Khan said.
"There is money out there in the donor community but in order to access that money, Sierra Leone has to improve the way in which it manages its health system," she said.
"They also have to ensure that they reach the women, particularly poor women in most remote areas."
The number of maternal deaths in Sierra Leone is a reflection of the dire situation in the West and Central Africa region where a woman has a one in 17 chance of dying from complications during pregnancy and delivery, in contrast to the one in 4,800 risk of death for a woman in the same situation in the United States of America,
according to United Nations Children's Fund (UNICEF).
KhanÂ?s visit to Sierra Leone marks the start of Amnesty InternationalÂ?s action against maternal mortality in the country.
A campaign caravan will tour Sierra Leone over the coming weeks acting as a vehicle for information and debate on the issue of maternal health.
Amnesty International plans to expand this campaign to Senegal, Mali and Burkina Faso in West Africa.
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