Human Rights Watch (HRW) recently released a report shedding light on the widespread prevalence of obstetric violence in Sierra Leone. This 80-page document, titled “No Money, No Care: Obstetric Violence in Sierra Leone,” highlights the challenges faced by women giving birth in public healthcare facilities. The findings are based on interviews with over 50 postpartum women who experienced health complications due to inadequate or delayed care resulting from their inability to make informal payments to hospital staff.
Despite the free health-care initiative launched by the government in 2010, aimed at improving maternal and child mortality rates, the study found that all the women interviewed still incurred costs for some parts of their care in public facilities. In 15 significant cases, women in urgent need of obstetric care were abandoned or saw their treatment postponed because they lacked financial resources. The report further indicates that the quality and timeliness of care often depended on the patient’s ability to provide informal payments.
HRW calls for urgent action from the Sierra Leone government to recognize obstetric violence as a severe violation of rights. The organization recommends improvements in the regulation and oversight of maternal and newborn healthcare providers. It also suggests increasing paid staffing and ensuring the availability of essential medical supplies, with the aim of reducing the reliance on out-of-pocket and informal payments. These recommendations could significantly affect the nation’s healthcare practices and policies moving forward.
Obstetric violence represents a form of gender-based discrimination within reproductive and maternal healthcare settings. It includes a range of abuses, such as non-consensual medical interventions, verbal and psychological abuse, withholding of pain relief, neglect, and denial of bodily autonomy. These practices severely undermine women’s rights and dignity during childbirth.
While Sierra Leone has made progress in recent years, including the decriminalization of abortion in 2022 and criminalization of child marriage in 2024, the country still holds the highest maternal mortality rate globally. These statistics underscore the pressing need for reforms in maternal healthcare services to ensure safer and more dignified experiences for women.
The full HRW report offering a detailed account of these issues can be found here.