Document - Sierra Leone: UN Secretary-General Ban Ki-moon must encourage the Government of Sierra Leone to do better on maternal mortality



June 15 2010

AI Index:AFR 51/004/2010.

Sierra Leone: UN Secretary-General Ban Ki-moon must encourage the Government of Sierra Leone to do better on maternal mortality

Amnesty International welcomes UN Secretary-General Ban Ki-moon's efforts to improve maternal health and his focus on the Millennium Development Goals (MDGs) in his visit to Sierra Leone. Amnesty International strongly believes that "Delivering solutions for girls and women” is a top priority, and that the MDGs cannot be reached without investment in women.

Amnesty International urges Secretary-General Ban Ki-moon to push for a continued emphasis on transparency and accountability in the implementation of the Government of Sierra Leone's free health care policy for pregnant women, lactating mothers, and children under five, and other initiatives to combat maternal mortality.

Amnesty International welcomes policies, initiatives and plans of action put in place by the Government of Sierra Leone and its commitments to improve maternal health. These commitments have the potential of making real the rights of women and girls enshrined in international and regional instruments, including in the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa.

However, there are gaps which continue to exist in the realisation of these commitments, and in light of the upcoming "Women Deliver" summit on MDGs in New York, Amnesty International urges Secretary-General Ban Ki-moon to help the Government of Sierra Leone give the elimination of preventable maternal death and ill-health the attention it deserves, notably by addressing the following crucial points:

The need to combat discrimination and end harmful practices

Discrimination against women, notably their low status in the family prevent them from making key decisions regarding their health, and other human rights violations including harmful practices, such as early marriages and female genital mutilation, can aggravate girls’ and women’s risk of maternal mortality and morbidity. It is therefore important that when addressing maternal mortality and morbidity in Sierra Leone, the government also addresses the need to combat such discrimination and harmful practices and guarantee women’s right to decide whether, when and how many children to have, in line with the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa.

The need to improve access to sexual and reproductive health and rights

New policies and strategies on sexual and reproductive health and rights are needed, in line with the African Union (AU) Maputo Plan of Action. In this plan, AU Member States commit themselves to repositioning family planning as an essential part of attaining the MDGs, addressing the needs of youth, reducing the incidence of unsafe abortions (including by providing safe abortion services to the fullest extent of the law), and delivering quality and affordable services to promote safe motherhood. Amnesty International believes that fulfilling all these commitments is crucial to saving women’s lives and ensuring they can exercise their rights to decide whether and when to become pregnant. We call on the Government of Sierra Leone to fulfil its monitoring and evaluation role in order to ensure that the commitments are followed by concrete, effective implementation. Access to information on sexual and reproductive health and rights, quality of family planning services – which must guarantee the right to confidentiality – and affordable contraceptive products, are of the utmost importance.

The need to improve quality of maternal care

Lifting financial barriers and improving sexual and reproductive health are both important, but reduction of maternal mortality and morbidity crucially depends on guaranteeing the availability and quality of maternal healthcare services. Shortages of blood, skilled medical personnel and supplies, as well as poor health infrastructure, are major contributing factors to maternal death and ill-health in Sierra Leone. The quality of care often influences the outcome of interventions and it also influences a woman’s decision of whether or not to seek care. In order to make free healthcare policies effective, governments need to take urgent steps to strengthen the health systems. This would include training of medical personnel, improving infrastructure facilities, effective referral system, equitable distribution of medical equipment and medicines and effective monitoring and evaluation systems. We call on the Government of Sierra Leone to concretely and effectively address these issues at the national level and ensure that quality maternal care is addressed as a priority concern.

The need to reinforce accountability and monitoring

Amnesty International calls on the Government of Sierra Leone to acknowledge the need to monitor and investigate possible shortcomings in the national health system. It is crucial that authorities are able to respond to allegations of corruption, demands for bribes, discriminatory treatment, abuse of patients, lack of facilities, non-availability of drugs, systematic malpractice, or other challenges with the support of an impartial facility-level or investigative authority such as an ombudsman. Patients and notably women should be informed on their right to redress and on the available complaint mechanisms. An investigative authority must have a strong mandate, be adequately resourced and be accessible, independent, and transparent and able to recommend remedies to improve delivery of health services. Women as users of sexual, reproductive and maternal health services need to be able to register complaints with and be heard by this authority, which must be able to provide remedy. We believe that all governments must commit to timely district-level investigations into maternal deaths, to use “UN process indicators” to monitor the availability, utilisation and quality of emergency obstetric care, and to improve reporting of deaths, including through civil registration systems. Accurate reporting and data collection is the first step to understanding the scope of maternal mortality and morbidity and can influence the way that services are delivered and accountability mechanisms are structured. We recommend ratification of the Optional Protocol to the International Covenant on Economic, Social and Cultural Rights which would allow women to petition the Committee on Economic, Social and Cultural Rights if their right to health is not fulfilled and they are not able to secure justice locally.

The Government of Sierra Leone has already taken major strides to ensure that girls and women do not die preventable maternal deaths and that they can exercise their right to make decisions regarding pregnancy – that progress must continue so that the government's stated commitments become a reality.

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