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Shifting the Focus on Surviving During Childbirth in Sierra Leone

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I come from a country where 1 in 23 women are at risk of not surviving during childbirth, where 1 baby dies every 46 minutes, and where evidence based resources on the state of maternal and newborn health is imperative to supporting government commitment to reduce maternal and newborn mortality in Sierra Leone. The Huffington Post recently published Save the Children's State of the World's Mothers report for 2013, Sierra Leone ranked high on the list of worse places to give birth. A grim reality perhaps, but I also work on a project that chooses to focus on the possibilities of survival. MamaYe, a DFID backed campaign is based on the ethos that change is possible when information is placed into the hands of the people. MamaYe is about changing fatalism to hope and channeling complacency into action by bridging information gaps between decision makers and the greater public. MamaYe is the belief in the tenacity of Africans to act for change and to become active agents in shaping their story to one of hope and change.

Ibrahim walks into the kitchen looking quite fazed as I stare at him, upset that he was late for work. "My wife died last night," he says flatly. I do not answer, I know she was pregnant. Ibrahim does not look me in the eye. He simply asks for time off. I do not react although my heart is pounding. "I'm so sorry; of course you can have time off. How is the baby?" I ask. "e day wit en granny", he says quietly in krio, meaning, "the child is with the granny". What proceeds next is a quick exchange of unmet glances while offering him money for his sudden funeral and permission to take a week off work. He walks out of the kitchen. I never see Ibrahim again.

Freetown, Sierra Leone is noisy. Come 6:00am in the morning and hens will be croaking, birds will be chirping on your window sill, loud almost broken down water tankers will be emitting dark fumes while spilling litters of water onto the streets. Freetown can be noisy in the morning; it is this very noise however that upholds the electric charm of the city. Sometimes the noise can be stifling, like the screams from a woman as she bursts into tears. That is often telling of a death. One particular morning, I hear such a scream. It is my 47-year-old neighbor, Esther, who just lost her 17-year-old daughter. She also gained a newborn grandson. Her daughter died during childbirth. The cause is major bleeding. That particular day, the noise carries sorrow. I ask Esther a couple of days later how she is feeling. "I dey try, na so God say" she replies. Translation, "I am okay, it is God's will."

We hear these stories far too much. MamaYe Sierra Leone, led by obstetrician Dr Mohamed Yilla reiterates that:

the issue of babies and maternal health should no longer just be a government issue; it should be of community interest because real powers lies in...invoking response in people to demand more from the their health services. Often there is a feeling if someone dies it is God's will. There is a cultural fatalism and we know it does not have to be this way,

Dr Yilla and his in country team of four are committed to shift thinking through evidence based advocacy. This approach will empower decision makers, who will be able to access consolidated and streamlined evidence and a public who will be able to use this evidence to better advocate for change. In effect, by bridging the information gap, solution focused approaches can be applied to ensure more lives of mothers and babies in Sierra Leone are saved.

MamaYe believes that every woman should survive childbirth. We ask for safe clinics for our mothers and babies, that more of our mothers are delivering in safe clinics, and that more funds are allocated to improving maternal and newborn health care services. Last year during Sierra Leone's elections, MamaYe, including non-governmental partners such as Save the Children and the Budget Advocacy Network, were able to influence policy decision when it distributed 5,000 score cards to communities, ranking health spending in each district and discrepancies in funds transfers. "We asked communities a simple questions while providing information. Did they know how much money was going to health services in their districts? When they saw the numbers, they too started to ask questions and in turn demand more," says Yilla.

I come back to Ibrahim who lost his wife and Esther who lost her teenage daughter and many others who tell stories about a health system that lacks care or technical support, and each time the stories are difficult to swallow. I remain hopeful though knowing that these stories contain an underlying theme, a call for change and this change begins with the people. Empowering the public with information about how to ask for safer clinics, empowering the government with information that helps measure progress and highlight gaps and encouraging strengthened collaborations amongst development agencies, and private sector.....change is inevitable because we will all be empowered enough to ACT NOW and ask for CHANGE. There will be no running away from the fact that every mother SHOULD survive during childbirth.

Visit MamaYe Sierra Leone for more information