Kinema, Eastern Sierra Leone, near the Liberia/Guinea border
March 6 2009. 6:30AM I met Mattu yesterday afternoon in the village of Gala, a 4 hour drive from Sierra Leone’s capital of Freetown, and an hour on a dirt road outside of Sierra Leone’s 2nd largest city, Bo. Mattu is 35 years old. Pregnant 8 times, she has 7 living the children. She brought the youngest, a 6 month old girl, with her to see Marie Stopes Sierra Leone’s clinical outreach team.
Mattu had wanted to stop having children some time ago. But she was unable to decide the number and spacing of her children. There were too many obstacles in her way, for too long -- a husband who refused to let her use contraception; illiteracy, and misconceptions about family planning; poverty. And perhaps most importantly, comprehensive family planning services were not available near her rural village.
A year earlier, she had managed to overcome nearly all of these barriers, and showed up at the Bo regional government hospital for a tubal ligation (sterilisation). She was told that she would need to pay 200,000 Leones ($US65). So she returned to her village, and had another child…..
Mattu heard that a Marie Stopes Sierra Leone rural outreach team would be visiting Gala, a small village with a rural health post. So she travelled the 8 miles there to have a tubal ligation. Mattu had finally overcome the last barrier to taking control of her fertility and her reproductive rights – access to services.
Mattu’s story is told millions of times over in Sierra Leone and around the world. In Gala alone, around 40 other village women had shown up for a tubal ligation or an IUD (intrauterine device) on the day that MSI’s clinical team arrived to provide services. Too many of these women had waited for far too long for family planning.
Yesterday, I also met Marianne at one of Marie Stopes’ Blue Star network private providers. MSI has introduced contraceptive implants to Sierra Leone via this private provider franchised network. Within a few weeks, 12 women had already received implants from this private provider alone. Marianne, 27 years old, has been pregnant 7 times, with 3 living children. With the implant, and because of Marie Stopes Sierra Leone and the Blue Star franchise, she is safe for the next 4 years.
In Freetown a day earlier, I visited MSI’s maternity centre, perhaps the best facility of its kind in this city of 2.5 million people. Obstetric emergencies and the riskiest births come to us. There, I saw a tiny baby, born prematurely at 28 weeks gestation and weighing 1 kg. Her mother was 15 years old. The baby now weighs 1.4 kg, and is one of the lucky ones.
We have all showed up late for Sierra Leone’s women, and we have let them down. After the war and chaos of the 1990s in Sierra Leone, it has taken far too long for women to get basic maternal and reproductive health services. Sierra Leone has amongst the highest maternal mortality rates in the world; and modern contraceptive use is a paltry 7%. And the two most popular and widely used methods in the world – IUDs and sterilisation -- almost don’t show up in surveys because their use is so small in Sierra Leone.
But it is better to show up late than to turn our backs on Mattu, Marianne, and the 15 year old mother in MSI’s Freetown maternity centre. MSI is doing what it can – around 1 in 6 of all Sierra Leonian women using modern contraception today are doing so because of MSI services. We would have done more, sooner, but there was too little funding for family planning in Sierra Leone. And too many donors prefer to fund only government health services, rather than pragmatically fund whatever works. So we have had to use MSI’s own discretionary funds, coupled with some European Union support, to scale up nationally, and to reach Mattu in her village with the life saving and life changing family planning services she has been waiting for.
I am proud to be part of MSI, and proud of the energy, drive, and commitment of the Marie Stopes team in Sierra Leone. We are making a difference in the most challenging places. In 2008, we provided over 1.2 million IUDs, sterilisations and implants to women just like Mattu and Marianne. Indeed, around 75% of MSI’s family planning impact is for underserved, largely rural and poor women. We are delivering family planning services that matter to the future of countries such as Sierra Leone, and that matter to women such as Mattu.
