New research from Médecins Sans Frontières (MSF) projects in Kabezi, Burundi, and Bo, Sierra Leone, shows more women’s lives can be saved if they have access to emergency obstetric care. The research indicates that it is possible to achieve a rapid and substantial decrease in maternal deaths of up to 74 per cent. MSF’s research is the first of its kind to quantify the impact of such a model of care on maternal mortality in an African setting. MSF data for 2011, now published in the paper: Safe Delivery: Reducing maternal mortality in Sierra Leone and Burundi , indicate that the introduction of an ambulance referral system together with access to emergency obstetric services can significantly reduce the risk of women dying from pregnancy-related complications.

Sierra Leone 2012 © Lynsey Addario/VII “You do not need state of the art facilities or equipment to save many women’s lives” says Vincent Lambert, MSF’s medical advisor for projects in Burundi. “MSF’s experience can serve as an encouraging example for donors, governments and other nongovernmental organizations who are considering investing in the improvement of access to emergency obstetric care in countries with a high maternal mortality rate.” MSF’s numbers indicate that maternal mortality in Burundi’s Kabezi district has fallen to 208 per 100,000 live births, compared to a national average of 800 per 100,000 live births* – a 74 per cent decrease. For the same year, in Sierra Leone, MSF figures indicate that maternal mortality in Bo district has decreased to 351 per 100,000 live births, compared to 890 per 100,000 in the rest of the country 1– a 61 per cent reduction. The comprehensive emergency obstetric care at MSF’s hospitals in Bo and Kabezi is offered 24 hours a day, seven days a week, and all services are free. The total annual running costs of the programs are equivalent to $1.90 for each person in Bo district and $4 for each person in Kabezi district.
Burundi 2012 © Sarah Elliott “Here in Sierra Leone, giving birth is often a life-threatening endeavour for many women,” says Betty Raney, obstetrician with MSF in Sierra Leone. “In my 25 years as an obstetrician, I have never seen such a level of severity among the patients. Had they not had any access to care, many of them would die.” Sierra Leone and Burundi both have extremely high rates of maternal mortality, due to problems around access to good quality prenatal and obstetric care linked to shortages of qualified health staff, a lack of medical facilities and health systems that have been shattered by years of civil war. MSF is the only emergency obstetric care provider in the Kabezi and Bo districts. An international point of reference is the fifth Millennium Development Goal of reducing maternal mortality by 75 per cent by 2015, compared to the national ratio in 1990. MSF’s estimates indicate that the maternal mortality ratio in Kabezi district is already below this level. In Bo district, MSF is confident that the mortality ratio will have dropped by 75 per cent by 2015.
Sierra Leone 2012 © Lynsey Addario/VII In 2011, MSF provided lifesaving emergency obstetric care to 3,647 women in the Kabezi and Bo districts. MSF has been providing access to emergency obstetric care services in Burundi since 2006 and in Sierra Leone since 2008. Some 287,000 women worldwide die each year giving birth, leaving behind children who – as a result of their mothers’ deaths – are 10 times more likely to die prematurely.

* National average, number of live births, from the World Health Organization.

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Safe Delivery: Reducing maternal mortality in Sierra Leone and Burundi (2012)