New UN statistics released last week show that world leaders are struggling to keep their promise of cutting the maternal mortality ratio by 75 per cent by 2015. For activists in Sierra Leone, the slow progress is no surprise.
"Many people don't understand that maternal health is a human rights issue and so many other factors contribute to these deaths. Discrimination, lack of facilities, domestic violence and poverty… if these underlying issues aren't addressed, it will undermine the good work that is being done," says Victor L Koroma, an activist based in the capital Freetown.
Koroma's small organization, the Campaign for the Promotion of Health and Human Rights Activities, campaigned to abolish medical fees in Sierra Leone. In April, the government took the landmark step of introducing free healthcare for pregnant and breastfeeding women.
However, Koroma warned world leaders gathering this week in New York to discuss progress on the Millennium Development Goals (MDGs) that more still needs to be done.
"We need to go beyond free healthcare because there are lots of problems. Many midwives are not properly trained and drugs and blood are not available. Nutrition is completely ignored. Drugs are unevenly distributed and there is discrimination - whether on the basis of tribe, gender, social status or political affiliation.
"World leaders, donors, the UN and the World Bank all need to do their bit if a country like Sierra Leone is to be saved from the ravages of pregnant women dying every day."
The UN statistics show an average annual decline of 2.3 per cent since 1990, falling way short of the 5.5 per cent decline needed to reach the 2015 target. Although a woman is no longer dying every minute, the new statistics show that one woman is still dying every minute and a half.
Severe discrimination and the low social status of women also fuel the high rate of maternal deaths in Sierra Leone, where women's health needs are given low priority by their own families and community leaders.
Koroma paints a harrowing picture of the scale of the maternal health crisis facing MDG decision-makers.
"Sexual and gender-based violence is rampant; women and girls as young as five are being raped. Many then become infected with HIV. Yet the government does nothing. In the last year only two people have been sentenced for violence against women out of probably thousands of cases," he says.
Most maternal deaths in Sierra Leone take place in rural areas cut adrift from hospitals. Most women die in their homes. Some die on the way to hospital; in taxis, on motorbikes or on foot.
"Women walk miles and miles to access these free medical programmes and sometimes they don't get there in time. We need an outreach programme that provides greater accessibility," says Edward Badasenjoh, who works at the University Hospital in the town of Njala.
"In my community people are really suffering. We have free medical care but it should reach everyone effectively. A lot of women in these rural communities are also victims of domestic violence..."
Activists in nearby Burkina Faso face similar challenges. In a country where only 10 per cent of people use modern contraception methods, even the government has admitted that reaching the MDG target is "unlikely".
"At the current rate, the MDG objective of 100 per cent of births attended by qualified medical personnel would only be achieved in 2045," says Juliette Compaoré, founder of ASMADE, which campaigns to raise awareness on sexual issues among young people.
"Achieving the objectives to improve maternal mortality depends on the decisions made by world leaders at this summit. Their decisions influence our national strategies for the implementation of maternal health policies and the global leaders in New York have to promote ambitious national policies."
Every year in Burkina Faso more than 2,000 women die from complications during pregnancy and childbirth, according to government figures.
The government, with the help of the donor community, has developed ambitious strategies that have lowered maternal death rates in some parts of the country. Yet these are undermined by a lack of accountability that allows medical personnel to get away with abuses, such as illegal demands for payments.
"Giving life is something natural, logical and justified, and allowing women to give birth safely is a moral and political duty of the world leaders. It is time for more action," says Compaoré.
Work on the MDGs is part of Amnesty International’s Demand Dignity campaign, which aims to end the human rights violations that drive and deepen global poverty. The campaign will mobilise people all over the world to demand that governments, corporations and others who have power listen to the voices of those living in poverty and recognise and protect their rights. For more information visit the Demand Dignity pages.