Anna Macauley, or Mama G as she is affectionately known, joined Marie Stopes Sierra Leone in 2000 as an outreach nurse. Rising through the ranks to become outreach coordinator, then national outreach coordinator, she is now the Clinical Services Manager. Here she explains the situation in her country.
One of the worst places to give birth
Sierra Leone was once the worst place to give birth in the world. People didn’t use family planning and women were having 11 or 12 children. They gave birth at home and I’m afraid, if there were complications, they often reached the hospital too late.
But things are changing. Our country has reduced its maternal mortality rate by 25% since 1990 15 thanks largely to the increase of long term contraception and more recently, the government’s ambitious free healthcare initiative for pregnant women, lactating mothers and children under five.
Marie Stopes Sierra Leone opened in 1986 with a single outreach team of two nurses. We’re now working across the whole country with 12 clinics, 12 outreach teams, an obstetrics clinic in the capital and a franchise network of 101 private providers.
Our growth has dramatically increased our impact and I am proud to say we now deliver a significant proportion of the country’s family planning services, preventing around 60,000 unwanted pregnancies and around 350 maternal deaths every year.
We complement the government’s work, particularly in hard to reach communities, helping to deliver services to people and build capacity in government health facilities. Where they can’t go, we go; what they can’t do, we do.
Before our outreach, many people had no access to contraception and there were lots of myths about family planning – there were rumours it made you sick or stopped you from ever conceiving. We bring information and services right where they’re needed, holding educational seminars and sharing information through songs, drama and comedy.
Working with partners we ensure the mission of reaching the unreached, and serving the under-served is fulfilled. We work with vulnerable groups, including youth, commercial sex workers and the disabled.
We have a big problem with teenage pregnancy here. Half of our young girls become pregnant before they turn 20 – and we’ve been educating teenagers in secondary schools so they know how to protect themselves if they are having sex.
Last year, 53% of our clients were under the age of 25 and a lot of young girls go through school without getting pregnant now. Innovation has been essential to our impact. In 2009, for example, we registered the Zarin (Sino-II) implant and it’s now the most popular choice for women. They prefer it because it is long term and is less embarrassing to have fitted than an IUD.
In 2011, we piloted the integration of family planning with child health services at government facilities, and saw a 75% uptake of services. This year, we will bring services to one of the country’s most underserved districts by boat, reaching coastal and riverside
Changing the lives of women
We’ve changed the lives of women and put a lot of smiles on a lot of faces. Women have choices, they know more about their bodies, and how to plan for their families. Our impact in Sierra Leone is clear but the team is not complacent.
By 2015, we hope to have reached 500,000 couple years of protection and, along with partners, help increase our country’s contraceptive prevalence rate to 30%.