Women: The Smartest Investment

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In an empowering speech on Friday, January 8, Secretary of State Hillary Clinton reiterated her commitment to women’s rights as human rights. Exactly 15 years since the UN’s International Conference on Population and Development was held in Cairo, Secretary Clinton praised the progress made in improving the health and lives of women and children around the world since this groundbreaking gathering.

This progress has included a marked increase in the use of modern contraceptives from less than 10% in the 1960s to 43% today; an encouraging increase in child survival rates; and an increase in female enrollment in schools. Despite this progress, Secretary Clinton rightly emphasized the crucial need for a continued commitment toward reaching the Conference’s goals by the target year, 2015.

Secretary Clinton cited alarming statistics: half the women in the developing world deliver their babies without access to crucial medical care and 215 million women worldwide lack access to modern forms of contraception – as Clinton put it, the “numbers are not only grim, but after 15 years, they are intolerable.” Vast gendered inequities remain; and women continue to represent the majority of the world’s “poor, unhealthy, and under-fed.”

Secretary Clinton and the Obama administration’s recognition that investing in women is “the smartest investment to be made…” shows that they’re on the right track. Earlier this year, President Obama and Secretary Clinton demonstrated their support for these issues by appointing Melanne Verveer as Ambassador-at-Large for Global Women’s Issues.  The creation of this position sends a strong message to the world that the United States, in its deliberations on foreign policy and foreign aid, will give top priority to issues that affect women. Ambassador Verveer has since been a strong advocate on behalf of women around the world.  In October, she testified before Congress in hearings in both the House of Representatives and the Senate on violence against women.

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More From Sierra Leone

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Brima Sheriff, Director of the Sierra Leone section, dancing with community in Mapaki ©Amnesty International

Brima Sheriff, director of the Sierra Leone section, dancing with community in Mapaki ©Amnesty International

Gouri has wrapped up her on-the-ground reporting from Sierra Leone — but the Amnesty International caravan is still campaigning for the right to maternal health. Follow Africa campaigner Khairunissa Dhala’s posts on the International Secretariat’s Livewire blog. Today: in the rain in Kabala.

Facing the Crisis of Maternal Mortality

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Gouri is in Sierra Leone this week to get a first-hand perspective of how maternal mortality affects the women and families living there. She will be sharing stories throughout her trip as a part of our Maternal Mortality in Sierra Leone series.

Wednesday, September 23, 2009

Amnesty Secretary General International Irene Khan (C) walks with Paramount chiefs after being named member of a local tribe on September 23, 2009 in Makeni. ISSOUF SANOGO/AFP/Getty Images

Amnesty Secretary General International Irene Khan (C) walks with Paramount chiefs after being named member of a local tribe on September 23, 2009 in Makeni. ISSOUF SANOGO/AFP/Getty Images

Today, we travelled with the caravan to Makeni, in northern Sierra Leone.  The trip from Freetown took us about three hours, and we arrived in Makeni to a festive welcome.  We were greeted by young women in traditional dress doing a traditional dance.  They had painted their faces and wore bushels of leaves on their backsides.  They danced around us and wiped our faces with a cloth (we were sweaty) when we entered town. Then we were escorted by the dancers along with a band and dozens of people in a slow (very slow) parade to the village chief’s headquarters in the center of town.  Once there, the village chief, a tall man, welcomed us and took us into a covered space for a small chat, where he told us how happy he was to have us come to Makeni to talk about maternal health.

The AI delegation split in two because we are a pretty large team.  The team I joined went to the hospital and the other went to meet with local civil society organizations.  We then travelled to the government hospital of Makeni to meet with the hospital staff and to talk with women in the maternity ward there.  This is the home town and district of Ernest Koroma, the current president of Sierra Leone.  The hospital here is similar to the one we saw in Freetown.  The maternity ward has 13 beds, all of which are full, and there is one labor room with only one mattress for women to rest on.  If more than one woman is in labor the others have to rest on the floor.  There is only one doctor who can perform deliveries and conduct surgery and we met with him during our visit.  He said a major problem in the country is the lack of doctors – he tells us there are less than a hundred in the whole country!  There seems to have been a major brain drain during and then after the war here. 

Amnesty International secretary general Irene Khan (C) visits a maternity ward at Makeni government hospital.ISSOUF SANOGO/AFP/Getty Images

Amnesty International secretary general Irene Khan (C) visits a maternity ward at Makeni government hospital.ISSOUF SANOGO/AFP/Getty Images

We met a young woman (who looks to me about 14 years old) who had to be rushed here because she had a retained placenta after giving birth to her little girl.  She delivered the baby at home, as most women do here, despite a new government plan that has stated that all deliveries should be in a clinic or hospital.  The current capacity in the hospitals could never manage that.  The young woman had a dilation and curettage at the hospital and seems to be recovering well.  The doctor and nurses told us that all the services they provide are free and no one has to pay.  But when we visited a private hospital later in the day and spoke to community members, they told us this was not true. 

This afternoon, we had a large event in the center of town with the caravan.  Hundreds of people attended, mostly children who had been brought there by their teachers.  We arrive to the event to smiling faces of little children in bright school uniforms and street clothes.  They scream, “hey, hey, hello” and laugh at us.  We must be quite the spectacle to them with our cameras and video equipment.  They giggle as we pass by, like they‘re in on a joke we will never really understand.  I think of how many of these children have lost their mothers and will never get to know the warm and reassuring stroke of a mother’s hand on their faces like my daughter knows.  The impact of maternal mortality touches them in a way we will never really fully comprehend.  They are left to aunts, grandmothers and friends to be raised. 

At the event, Irene Khan, the secretary general of Amnesty, is made the first ever woman village chief of Bombali, the region we are in.  Irene uses the opportunity to ask the community to consider the role of women and to allow them to have a greater voice in the issues that impact them. 

During her address at the event, Irene asks once again how many people know a woman who has died during child birth or during pregnancy.  Most of the hands in the crowd go up.  It’s sad to see such little arms raised around such a devastating reality.  The fact is that Sierra Leone is not alone in facing this crisis, and it really is a crisis – a human rights crisis.  More than half a million women die every year giving birth.  It’s a global crisis which we are beginning to highlight here in Sierra Leone.  But Amnesty is doing a similar report in Burkina Faso and we will be doing a report in the United States as well.  Even in the richest, most powerful country in the world, the United States, women die during child birth because they cannot afford health care.

We called for an end to maternal mortality, the crowd went wild

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Gouri is in Sierra Leone this week to get a first-hand perspective of how maternal mortality affects the women and families living there. She will be sharing stories throughout her trip as a part of our Maternal Mortality in Sierra Leone series.

Tuesday, September 22, 2009

Amnesty Secretary General International Irene Khan (C) addresses crowd during the campaign launch against maternal deaths in Sierre Leone. ISSOUF SANOGO/AFP/Getty Images)

Amnesty Secretary General International Irene Khan (C) addresses crowd during the campaign launch against maternal deaths in Sierre Leone. ISSOUF SANOGO/AFP/Getty Images)

Just back from the official launch of the Sierra Leone Maternal Mortality report (pdf).  Amnesty launched the report at a school’s grounds near Princess Christian Maternity Hospital in Freetown.

There were several thousand people there for the launch as a result of the outreach done by the Amnesty International section in Sierra Leone.  AI Sierra Leone is led by Brima Sheriff, the director, and Violette Kawa, the chair of their board.  Brima is a dynamic and articulate man who talks about human rights in Sierra Leone with passion and knowledge.  AI Sierra Leone, with a staff of less than a dozen people, has been working night and day over the past few months getting ready for the launch of this report.

It was raining buckets this morning and last night.  It’s the rainy season here.  When we woke this morning everyone was nervous about launching in the torrential downpour and what that would mean for the turnout. But the skies cleared up and the sun even came out just in time for our launch at 4:30 p.m. when Violette brought the crowd to a roar by asking them, “Is it right for a woman to die because she is poor?”

Hundreds of children in their school uniforms along with their mothers and fathers attended the launch at Bishop Johnson Memorial School.  Even the nurses and staff from the nearby hospital came out to support the call for ending maternal mortality.  “Maternal mortality” — the words themselves seem to sanitize what is really happening – women dying as they become mothers.

Irene Khan, Secretary General of Amnesty, asked the crowd, “How many of you know a woman who has died during child birth?”  Almost all of the hands among the thousands went up. A part of Amnesty’s work here is to inform women and their communities that this does not have to be the case.  We are talking to them about their rights and the obligations that their government has to provide safe and affordable health care.

Sierra Leone has signed and ratified the International Covenant of Economic, Social and Cultural Rights and the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) which guarantee the right to the highest possible standard of health in general and the right to maternal health in particular, as well as protection against discrimination based on income.  (The United States has not ratified the two conventions, although we hope the Obama administration will change this.)

Women in Sierra Leone crowd around to read Amnesty International. (ISSOUF SANOGO/AFP/Getty Images)

Women in Sierra Leone crowd around to read Amnesty International. (ISSOUF SANOGO/AFP/Getty Images)

The launch also included signers and a famous (really famous) Nigerian actress named Omotola (she does not need a last name here).  Omotola was the star of today’s rally.  The crowd went wild when she entered the grounds and it took more than a dozen police officers to safely bring her to the stage.  Omotola, looking lovely in her bright yellow Amnesty shirt, spoke with passion  about the right of women to have safe childbirth and about women not being denied care because they are poor.  The crowd went crazy.

She was followed by a theater performance group that played out a woman’s trials of giving birth here and

her eventual death because her husband could not scramble together the money demanded by the hospital for her care.  The enthusiasm and energy of the crowd was exhilarating and made me feel that ending maternal mortality here was not only possible, but within reach.

Tomorrow, we leave with the caravan of musicians, performers and Omotola, along with Amnesty directors from several sections, for Makeni, which is in the Bombali region northeast of Freetown.  The group in this caravan  will talk about maternal mortality and encourage the people of Sierra Leone to demand better care from their government.  It will travel around the country for the next two weeks.  It’s the caravan of life; a reminder to women and their families that dying during child birth is not inevitable and can be prevented.  We need the government to make this issue a priority. There needs to be the political will to ensure women will not die from preventable causes.

The women I met in Sierra Leone are lucky to be alive

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Gouri is in Sierra Leone this week to get a first-hand perspective of how maternal mortality affects the women and families living there. She will be sharing stories throughout her trip as a part of our Maternal Mortality in Sierra Leone series.

Sunday, September 20th:

Gouri (R) speaks with Saffitu (L), a woman who recently lost her twins during labor. AFP

Gouri (R) speaks with Saffitu (L), a woman who recently lost her twins during labor. AFP

I arrive in Sierra Leone Sunday at 3:30 p.m. From the airport there are two ways to get to Freetown, the capital: by boat or by helicopter. We take the ferry along the Atlantic Ocean, which takes about 35 minutes, and we arrive in Freetown. Freetown seems to have grown around itself. Its infrastructure barely seems to be able to handle the demands of the city and its people. We travel by car to the hotel and I’ve never seen as many potholes (craters really) in my life. After I left India, where I was born, I never thought I would say this about another place.

Once at the hotel, we are asked to go to the Princess Christian Maternity Hospital (PCMH), in the center of town, right away. We need to get there before dark because lighting at the hospital is bad and also because travel after sunset is not safe. We arrive at the hospital and after some negotiations the head nurse agrees to let us to visit two of the wards in the hospital.

The first ward we visit is Labor Ward 3, which is for women who have had pre-natal complications that have resulted in c-sections. The hospital is not a happy place. The families of the patients sit on the stairs leading up to the hospital’s entrance. Their faces convey the anxiety and fear that we see more explicitly on the faces of the women in the ward itself. At the entrance to the hospital there is a huge sign that lists the prices of the services provided. We see the signs inside the hospital as well even though the government has said they guarantee free service for those in need.

The inside is dark and seems more like an abandoned building than a hospital. It’s lit with florescent lights but only in some sections. The hallways and lobby area remain dark to conserve light. The nurses look exhausted and resigned to the conditions that surround them. We enter the “ward”, just a section of space separated by curtains from the hallway. It has two rows of about a dozen beds. At one end of the ward there is an old television. It is on and it seems to provide some form of diversion for women who’ve lost their babies or who are in severe pain from giving birth. A mosquito net hangs over each bed, and a small basket or crib sits next to it.

I meet Ester, who had complications during labor and has lost her baby. She’s 35 years old and has no other kids. She’s visibly, and understandably, sad. Her eyes convey her internal struggle to make sense of what has happened as well as to make peace with it. She was brought to the hospital after having a difficult labor. As is the case with most of the women here, Ester came to the hospital as a last resort. One, because it’s expensive and very few have the means to pay for it and two, because the community does not seem to trust the quality of service provided. Women are brought here only if something has gone terribly wrong and there is no other option.

We hear of the fees the women are asked to pay before any services are provided. These fees are even higher than the signs inside and outside of the hospital indicate. The health care providers seem to charge based on their assessment of the patients’ ability to pay. One of their aims is apparently to recover costs of medicine and equipment that they pay for themselves, upfront, and then recoup from patients. This leaves women and their families left to negotiate prices for medical care at one of the most vulnerable times in their lives.

A woman discusses her difficult delivery while allowing Gouri to hold her child. AFP

A woman discusses her difficult delivery while allowing Gouri to hold her child. AFP

Across from Ester is another woman who is holding her newborn. As I approach her, she lifts her baby towards me and quickly puts him in my arms. I was surprised, not expecting to hold a newborn. After all, if I was in a U.S. labor ward, I’d be peering at the little one behind a solid glass wall to ensure that the baby wouldn’t catch any germs. The baby boy, who is wrapped in a little blue jumper and a matching cap that make him look like he’s got bunny ears, is named David. David has a face that is perfectly formed, unlike most newborns, whose faces look like those of little old men. David has a perfect nose and full lips. His eyes are closed and he sleeps peacefully in my arms. I talk with his mom and she speaks of her difficult delivery. She won’t talk about details of what brought her here to the hospital. She only says she’s waiting for her milk to come in so she can feed David. She’s clearly been through a great deal in the labor and is visibly weak.

Before I leave the ward, another woman asks to speak to me. Her name is Saffitu. She was pregnant with twins. As she went into labor it became clear that she needed to get to the hospital. Most “normal” births in Sierra Leone are performed by traditional birthing assistants (TBAs) who are either elderly women in the community or the first wife of the husband. TBAs are not trained and do not receive any government aid or supplies. They are left to their own devices and their own practices in helping the vast majority of women in Sierra Leone give birth.

Saffitu tells me both her babies died during birth. One of the twins was breached and the other baby was stuck behind it. She says her heart is in pain because she’s grown attached to them. She says “You see, I could feel them move inside me. I knew and loved them. They are not here.” I struggle to find words to console her. I have none. I can only think to ask if she has other children. She says yes. She has a 5 year old boy at home. She’s been in the hospital for 17 days and she is missing him. I tell her (and her husband outside) that she needs to take care of herself so she can be there for him. She holds my hand and squeezes tight. She’s heard about why we’ve come to talk to the women in the ward. Her squeeze affirms she wants her story told so someone else can avoid living it.

PCMH is considered the best hospital in the country. It’s one of a handful of hospitals in the country that has a maternity ward. This is what the women of Sierra Leone have to count on. In Sierra Leone, one in eight women dies during child birth or pregnancy. That’s one of the highest rates of maternal mortality in the world.

On Tuesday, September 22, Amnesty will launch a report on maternal mortality in Sierra Leone that documents the struggle of mothers who are dying. Together with this report, we’re launching a five-year campaign to pressure the government and donor countries to make maternal mortality a priority.

In a way, the women I met at PCMH are lucky. They at least are alive.