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A Woman's World

A Woman's World

The Struggle for Equality Around the Globe  |  Special Report

A Mother's Final Look at Life

Sierra Leone has the highest rate of maternal mortality in the world. Hospitals lack basic equipment and medication, and factors such as poverty and lack of transportation make every pregnancy a gamble.

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[Map: Sierra Leone]
Story by Kevin Sullivan
Photos by Carol Guzy  
The Washington Post
Sunday, October 12, 2008

FREETOWN, Sierra Leone -- Fatmata Jalloh's body lay on a rusting metal gurney in a damp hospital ward, a scrap of paper with her name and "R.I.P." taped to her stomach. In the soft light of a single candle -- the power was out again in one of Africa's poorest cities -- Jalloh looked like a sleeping teenager. Dead just 15 minutes, the 18-year-old's face was round and serene, with freckles around her closed eyes and her full lips frozen in a sad pucker.

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Her bare feet stuck out from the colorful cloths in which she had been wrapped by the maternity nurses who had tried to save her life. Her toenails bore the chipped remnants of cheery red polish.

In the dark hallway, her sisters and friends hugged and wailed, "Fatmata! Fatmata!" in a tearful song of grief.

Eight hours earlier, Jalloh delivered her first child: a healthy baby boy. Her official cause of death was postpartum hemorrhaging. She bled to death giving birth in a part of the world where every pregnancy is a gamble.

More than 500,000 women a year -- about one every minute -- die in childbirth across the globe, almost exclusively in the developing world, and almost always from causes preventable with basic medical care. The planet's worst rates are in this startlingly poor nation on West Africa's Atlantic coast, where a decade of civil war that ended in 2002 deepened chronic deprivation.

According to the United Nations, a woman's chance of dying in childbirth in the United States is 1 in 4,800. In Ireland, which has the best rate in the world, it is 1 in 48,000. In Sierra Leone, it is 1 in 8.

Maternal mortality rarely gets attention from international donors, who are far more focused on global health threats such as malaria, tuberculosis and HIV-AIDS. "Maternal death is an almost invisible death," said Thoraya A. Obaid, executive director of the U.N. Population Fund.

The women die from bleeding, infection, obstructed labor and preeclampsia, or pregnancy-induced high blood pressure. But often the underlying cause is simply life in poor countries: Governments don't provide enough decent hospitals or doctors; families can't afford medications.

A lack of education and horrible roads cause women to make unwise health choices, so that they often prefer the dirt floor of home to deliveries at the hands of a qualified stranger at a distant hospital.

Women die in childbirth every day, according to people who study the issue, because of cultures and traditions that place more worth on the lives of men. "It really reflects the way women are not valued in many societies," said Betsy McCallon of the White Ribbon Alliance for Safe Motherhood, one of the few groups that advocates to reduce deaths in childbirth. "But there is not that sense of demand that this is unacceptable, so it continues to happen."

Saidu Jalloh said he and Fatmata had been excited about their first baby.

Saidu, 27, a Freetown grocery vendor, said that after marrying a year ago, the couple rented a room in a house in the city's Brima Lane neighborhood. Fatmata had grown up nearby, in a cluster of small shacks shared by more than 25 relatives. Like many African men, her father is a polygamist, with three wives. Fatmata was the eldest child of her mother and the fourth-oldest of her father's 16 children.


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