The Worst Place on Earth to be Born

Samantha Bailie
Street News Service

Most people in developed nations
expect to give birth to a healthy baby
that grows into a healthy child. Sierra
Leoneans however do not enjoy this
basic human ‘right’. One in four children
dies before their fifth birthday in the
West African country, giving it the highest
child mortality rate in the world.
Concern Ireland, led by Country
Health Programme Coordinator, Rajeev
Vishwakarma, aims to change such
morbid statistics. The charity is operating
in five chiefdoms of western urban
and rural districts of Sierra Leone to
assist the most vulnerable people. This
includes women of reproductive age
(pregnant and lactating mothers) and
children under 5 years old in order to
reduce the child mortality rate.
Sierra Leone is officially the worst
place in the world for a child to be born.
Hospitals are too hot and overcrowded
and there is little antenatal care. Even
when babies do make it through labour,
they are instantly exposed to diseases
like Malaria, Diarrhoea and Acute
Respiratory Infections (ARIs).
“We are attacking disease through
prevention, promotion and treatment.
We work with different organisations
like the Ministry of Health and
Sanitation (MoHS), Government of
Sierra Leone, UNICEF and Voluntary
Service Overseas (VSO) to deal with
these issues and other maternal and
child health needs,” says Vishwakarma.
Despite the input of such a varied
group of well meaning organisations,
diseases like HIV and AIDS remain
problem in Sierra Leone with Sub-
Saharan Africa having the highest infection
rate in the world.
“Our health programme’s primary
objective is Preventing Mother-to-Child
Transmission (PMTCT) to support government
efforts, ensuring universal
access to PMTCT services. [The] overall
goal is to reduce mother to child transmission
of HIV among childbearing
women by 50% by end of 2010 with specific
objectives that include increasing
male involvement in PMTCT by 75%,”
says Vishwakarma.
Malnutrition is another major underlying
cause of infant mortality in Sierra
Leone. One of the most harmful cultural
practices is the lack of breastfeeding. In
many parts of Sierra Leone new born
babies are fed a diet of water and rice
instead of breast milk.
Unfortunately this means that babies
are given a higher exposure to potentially
contaminated food and water.
Considering only 10% of mother ’s
breastfeed exclusively for the first 6
months, this is a huge problem.
In spite of the widespread nature of
this problem, Vishwakarm is confident
that Concern Ireland is attempting to
address the issue.
“We are educating and sensitizing
pregnant women and mothers through
conducting 22 regular sessions on different
topics including pregnancy moni-toring and care, nutrition and breastfeeding.
We are improving access to
improved drinking water and we have
a Food Income and Market programme
in operation to enhance food security in
target areas,” he says.
“We have initiated Community
Led Total Sanitation (CLTS) approach
to promote environmental sanitation.
Community health workers and traditional
birth attendants have been
trained to conduct house to house visits
for health promotion to identify and
refer cases related to malnutrition and
immunization drop outs. A pilot initiative
is in progress to open a community
based ‘mami pikin welbody kitchen’
(Mother and Child healthy kitchen) to
promote community health and nutrition
for pregnant women and children
under fives through integrating pregnant
women and mothers’ club sessions,
hygiene promotion, preparation
and use of low cost nutritious recipes in
the daily food basket.”
In spite of such programmes and initiatives
however, many of Sierra Leone’s
deeply embedded cultural practices are
also detrimental to child survival. Early
and underage marriage and non-attendance
at school is commonplace and
can lead to child exploitation.
“We are addressing issues related to
teenage pregnancy and underage marriage
such as encouraging children to
stay in school, and encouraging parents
to actively ensure their children
attend school. Teenage pregnancy is
on the rise in Sierra Leone and people
are frightened to send their girls out to
school. Concern [Ireland] has been liaising
with community heads and elders,
involving parents, teachers and women
groups to take necessary action by setting
bylaws to establish social control
and it also raised issues at various platforms
to deal with these issues,” says
Another of the main challenges now
and for the future in Sierra Leone is how
to address food security and nutrition
while rebuilding agriculture, ensuring
people will have the right foods to
eat and be educated nutritionally. This
is another aspect of development that
Concern Ireland is aiming to address.
“We have a Food Income and Market
(FIM) programme which is working
towards food security and reducing
the hunger gap through agricultural
development, market access, promoting
micro-enterprises and animal husbandry.
We have a health management
committee to promote group farming
to generate income for health facilities,
to promote diversified and nutritious
foods in the household daily food basket,”
Vishwakarma states.
In recent years Sierra Leone has made
remarkable progress in reducing maternal
mortality and increasing access to
reproductive healthcare, however many
challenges remain. With the assistance
of groups like Concern Ireland, Sierra
Leonean women and their children
may finally be able look towards a more
healthy and prosperous future.