The real pro-life programme

Much as we read about the anti-abortion campaigns to protect the unborn , little do these groups draw from the reality of the real world in advocating change.

Over 7000 babies are stillborn, some 5 480 newborns die within 24 hours and almost 1000 mothers die every day in the world.

Ninety percent of all maternal deaths could be prevented if pregnant women were cared for by trained midwives, with specialised back-up in case of emergencies. This is according to the first-ever report on the State of the World's Midwifery released at the International Confederation of Midwives in Durban.

A woman's chance of dying as a result of pregnancy is one in 31 in sub-Saharan Africa and one in 4 300 in the developed world.

There is a global shortage of at least 350 000 midwives. The World Health Organisation recommends one midwife per 175 pregnant women, but in Rwanda, for example, there is one midwife per 8 600 births.

The five major causes of maternal death during 2005-2007 were non-pregnancy related infections, mainly AIDS (43.7%), hypertension (15.7%), haemorrhage (12.4%), sepsis (9.0%) and pre-existing maternal disease (6.0%). Some 38,4% of the 4,077 maternal deaths reviewed were avoidable within the health care system.

"Safe childbirth is not a luxury, it is a human right," said Bunmi Makinwa, the Africa Director for the UN Population Fund.

At Ola During Children's Hospital in Freetown, Sierra Leone's capital city infants are crammed two or three to a bed, sometimes more. Since the introduction nearly 14 months ago of free health care for pregnant women, lactating mothers and children under five, the number of people coming to seek treatment has shot up. Staffing and equipment has not risen to match, leaving health workers struggling to deal with the influx. Sierra Leone's ambitious plan to tackle one of the world's highest rates of maternal mortality and infant death has garnered much praise. In a country where one in five children dies before their fifth birthday, and one in eight women dies from complications of pregnancy or childbirth, free health care is seen as a huge step forwar. But reports of corruption within the system are widespread. Patients recount being asked to pay for services and medications that should be free, or having to buy drugs when hospital supplies are said to have run out.

"People are still paying for a lot of drugs and a lot of services," says Birma Sheriff, Amnesty International's Sierra Leone country director. "This is not a secret. Everyone knows that people are still being asked for money, and it's going into the private pockets of someone, at the expense of the women. The free health care was supposed to be for women but cost is still stopping them."

Government-run hospitals saw about three times as many children under five - nearly three million - in the first 12 months of the program as in the preceding year. More than 126,000 women gave birth in hospital in the first year of the program, compared to about 87,000 in the previous year. The number of maternal complications treated in hospital increased from about 8,000 to over 20,000.

"Although the number of health staff has been increased since the launch of free health care it is still insufficient to match the service delivery demand," said a government report.

Dr. Mahmoud Idriss Kamara says the pressure on staff posed by the patient increase is wearing everyone down. Kamara sits behind a battered table, answering questions in between instructing staff, shuffling files, answering phones and signing the death papers for the child who'd just died. He has more than 24 hours left in his shift before he'd be able to get some sleep. Nurse Lucy Macauley says staff exhaustion leads to a poor standard of care for patients. She says they need help and the increase in workload should be accompanied by pay raises. "We're working harder, but for the same pay," says Macauley. Much of the equipment is obsolete and there are chronic shortages of supplies, she says, and the complex, which houses a maternity hospital and a children's hospital, has an inadequate water supply - often, there simply isn't any.

In Sierra Leone 70 percent of the population lives on less than one dollar a day. There are fewer than 100 doctors for some six million people and most health facilities are poorly equipped and lack basics like water supply and electricity.