There are few more important events in many women’s lives than childbirth. Yet in post-war Sierra Leone you have a one in six chance of dying while giving birth. So in 2000 ActionAid began offering training courses for traditional birth attendants.

Sierra Leone was, until recently, the poorest country in the world. A 10-year civil war had taken a heavy toll on an already poor country. Healthcare suffered to such an extent that it now has the highest maternal mortality rate in the world, as well as the highest number of deaths in under five-year-olds.

Looking Town is a poor hillside community named for its commanding views over the capital, Freetown. Until recently Looking Town was much the same as the rest of the country, everyone knew someone who had died in childbirth. People here were in desperate need of medical knowledge and equipment.

In 2000, 54 women were trained in ante- and post-natal care to deal effectively with uncomplicated births and, crucially, to quickly recognise potential problems and insist that women were taken to hospital in time.

Learning for life
Six years later, the learning continues in Looking Town. At least 20 babies have been brought to an ActionAid health session, each weighed in the old fashioned blue cross harness that hangs from a mango tree and, for a chosen few, it is also time to be vaccinated.

Older girls and women listen to speakers who are giving a talk on family planning, contraception and the importance of vaccination. Most of the mothers at the session have given birth with the help of a trained birth attendant, and it will have made a big difference to their chances of survival.

"Before I received my training I had no knowledge of even basic things like using gloves to protect myself, the mother and the baby," says Hawa Koroma, the birth attendant who is leading the health talk. "Now I am cautious and I don’t take unnecessary risks."

Up the road in Kola Tree community, 22-year-old Jariatu Sesay has just given birth to a baby daughter, her third child. She was helped through her labour by Mary Kamara, another of the trained birth attendants, and is relieved that everything went smoothly. "I was worried during my pregnancy," says Jariatu. "It is a very stressful time and there are not many resources here. I could not have afforded hospital if something bad had happened. But I am very happy now."

Isatu Kargbo, another ActionAid trained birth attendant in Kola Tree winds her way with a large medical bag in her hand and a wooden box on her head. She has just visited one of her prospective patients, an eight-month pregnant woman, who is showing all the signs of a healthy pregnancy.

Isatu is illiterate. But the box she carries allows her a simple method of record keeping. It contains five different coloured slots, into which Isatu drops a marker each time she attends a birth: blue for a live birth; white stillbirth; red marks a death; green is premature and black for a hospital referral.

A new beginning
There is no denying there is a new spirit of freedom in Sierra Leone, mirrored by people like Isatu and Mary, who can sense a future for the first time in a long time. Both women talk of their plans to learn more, to teach others, even to help build health centres in their communities.

Even the government admits that the birth attendants are filling a huge gap in an under-resourced health service. "Trained birth attendants are very, very useful to us," says Dr Amara Jambai, the government’s Principal Medical Officer for the western region. "They carry health information straight to the heart of communities. They offer a path directly to people that we would never otherwise reach." In Freetown there is less than one government health worker trained to deliver a baby for every 6,000 people.

The country still faces huge obstacles such as debt, instability and mass unemployment. But Sierra Leone has been at peace for four years now. The will of the people is to put the past behind them.

photo : ©Jenny Matthews/ Actionaid