DEATH IN CHILDBIRTH CONTINUES IN SIERRA LEONE: THE SAFE MOTHERHOOD BILL FAILS TO PROTECT MOTHERS

In the wake of persistent tragic maternal deaths, Sierra Leone’s healthcare system stands at a critical crossroads. The 2024 Safe Motherhood and Reproductive Health Care Bill (the Bill), a pivotal government initiative, appears to be a beacon of hope in the nation’s maternal health crisis. Yet, the burning question remains, ‘Could this legislation, if enacted, prevent women’s untimely demise’? The answer not only underscores the potential of policy solutions in averting maternal deaths but also highlights the pressing need for immediate and decisive action.

The devastating reality of maternal healthcare in Sierra Leone is evident in the daily operations of its government hospitals and clinics. Women arrive hoping for safe deliveries but instead face dark operating and delivery rooms due to power cuts, unauthorized procedures by inexperienced staff, and health workers’ abandonment of patients in moments of critical need. These are not isolated incidents but systematic failures that the new Bill largely ignores. Women who should be celebrating new motherhood instead become mere statistics in Sierra Leone’s persistent maternal mortality crisis.

THE BILL AND MATERNAL MORTALITY

With its ambitious scope and comprehensive approach, the Bill is a step in the right direction. It promises ministerial oversight, designated facilities, and comprehensive services. It speaks of protecting vulnerable groups and ensuring non-discrimination. This potential for positive change is a ray of hope in the fight against maternal mortality.

The Bill proposes a framework for comprehensive maternal healthcare delivery through several key provisions,

• Minister’s Implementation Responsibility (Section 3).

• Designation and Authorization of Facilities (Section 4).

• Provision of Comprehensive Services (Section 4).

• Support to Vulnerable Groups (Section 6).

• Confidentiality and Privacy (Section 7).

• Non-Discrimination (Section 8).

• Informed Consent and Right to Refuse (Sections 9 and 10).

• Funding and Financial Provisions (Sections 12-15).

It mandates various services, from preconception care to emergency obstetric services. It requires the designation of proper facilities and promises financial support through government allocations and grants. Most importantly, it enshrines the right to safe motherhood as a fundamental guarantee.

WHAT THE BILL PROMISES

While the Bill promises comprehensive maternal healthcare delivery through ministerial oversight and designated facilities, it critically fails to address many fundamental issues that contribute to maternal deaths. The Bill contains no provisions for professional ethics to ensure continuous patient monitoring, prevent patient abandonment, or establish consequences for medical negligence. The absence of ethical guidelines and enforcement mechanisms in the Bill leaves patients vulnerable to substandard care and professional misconduct.

Equally crucial is the Bill’s failure to set minimum hospital infrastructure and equipment standards. Its silence on requirements for backup power systems is a glaring omission in a country where power failures regularly compromise critical medical care. The power failures and lack of essential equipment that compromise maternal healthcare will continue under this new legislation.

THE GAP BETWEEN POLICY AND PRACTICE

This Bill, as it is now, would most likely NOT save the lives of many women because it fails to address the systemic failures that often lead to their deaths and injuries. The critical gaps include,

• No robust accountability mechanisms

• Lack of specific professional standards and disciplinary measures

• Absence of infrastructure and equipment requirements

• No clear quality control measures

• Missing protocols for emergency procedures

Policy without an enforcement mechanism is merely a farce. The Bill lacks accountability mechanisms, including

• no maternal death audits,

• no professional disciplinary procedures, and

• no patient grievance processes

These omissions mean that maternal mortality tragedies will continue to unfold in Sierra Leone with impunity. The lack of specific quality control measures and monitoring systems leaves healthcare facilities without sufficient oversight. To truly honor the memory of all the women lost in the maternal mortality crisis and prevent future deaths and morbidities, the Bill needs substantial amendments.

RECOMMENDATIONS

To truly prevent maternal deaths and morbidities in Sierra Leone, the Bill must be amended to establish clear professional standards and accountability, modeled after developing countries that have successfully reduced maternal mortality, including:

Malaysia’s Mandatory Supervision Protocols,

• Requiring senior clinician presence for all emergency procedures.

• Implementation of the WHO Safe Surgery Checklist.

• Clear chain of command in obstetric emergencies.

Rwanda’s Essential Facility Requirements,

• Mandatory backup power systems with automatic switching

• Essential equipment checklist for maternal care units

• Regular infrastructure audits

• Emergency response systems

Resource Management,

• Blood bank requirements for all surgical facilities

• Minimum stock levels for essential medicines

• Equipment maintenance protocols

Sri Lanka’s Comprehensive Audit System,

• Mandatory maternal death reviews within 48 hours

• Monthly facility-level performance reviews

• Regional maternal mortality committees

• Public reporting of maternal health indicators

Patient Rights and Grievances,

• Establishment of patient advocacy offices

• Clear complaint investigation procedures

• Compensation framework for negligence cases

• Public reporting requirements

Thailand's Emergency Surgical Standards,

• Clear qualification requirements for performing C-sections

• Mandatory team briefings before emergency procedures

• Documentation requirements for all surgical decisions

• Regular skill assessments for medical staff

Emergency Response,

• Standardized emergency protocols

• Regular emergency drills

• Clear referral pathways

• Transport arrangements for emergencies

Bangladesh’s Quality Assurance Continuous Monitoring System,

• Regular clinical audits

• Patient satisfaction surveys

• Staff performance reviews

• Quality improvement committees

Training Requirements,

• Mandatory continuing education

• Emergency skills updates

• Communication training

• Leadership development for senior staff

BEYOND LEGISLATION

No legislation by itself can prevent maternal deaths. The stories of many maternal mortality victims teach us that change must occur at multiple levels, from hospital administration to medical education, infrastructure development, and professional culture. The normalized negligence that contributes to patients’ deaths is a deep systemic issue that no single piece of legislation can address. It demands a fundamental shift in how healthcare workers view their responsibilities, how hospitals manage their operations, and how the healthcare system responds to failures. This cultural shift is not just a recommendation but a necessity for improving Sierra Leone’s healthcare system, and it’s a change in mindset that we must all strive for as Sierra Leoneans.

Ultimately, the true measure of this Bill, or any legislative reform, will be whether it can prevent the next maternal death or injury. As it stands, this Bill falls short. However, proper amendments and robust implementation could help create a healthcare system where every mother receives the care she deserves and where negligence and infrastructure failures no longer claim lives that could have been saved.

The key question now is whether Sierra Leone’s lawmakers will heed these calls to amend and strengthen the Bill accordingly. The deaths of so many women demand nothing less than transformative change, change that this Bill, in its current form, does not deliver. For every mother who walks through a hospital door today, every child who deserves to grow up knowing their mother’s love, and every family that should remain whole, we will continue to speak out, urging our society toward a future where motherhood no longer carries a death sentence.