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Female Health and Family Planning in Sierra Leone

Groen, Reinou S. MD, MIH; Solomon, Julie MD; Samai, Mohamed MBBS, PhD; Kamara, Thaim B. MD; Cassidy, Laura D. MS, PhD; Blok, Lucie MD, MPH; Kushner, Adam L. MD, MPH; Dhanaraj, Mitra MD; Stekelenburg, Jelle MD, PhD

doi: 10.1097/AOG.0b013e31829a2808
Global Women's Health: Original Research

OBJECTIVE: To describe the current status of access to maternal care, family planning use, and place of delivery in Sierra Leone, one of the poorest countries in the world with one of the highest maternal mortality rates.

METHODS: Data from the Surgeons OverSeas Assessment of Surgical Need, a cross-sectional two-stage cluster-based household survey conducted in Sierra Leone in 2012, were analyzed to determine access to maternal care, family planning use, and location of delivery.

RESULTS: Of 3,318 females of reproductive age (12–50 years of age), 1,205 participants were interviewed in depth. Twenty percent (95% confidence interval [CI] 17.9–22.5) of respondents reported using family planning methods; injectables were the most frequently used method. Fifty-nine percent (95% CI 54.0–63.0) of the recalled deliveries took place outside of a health facility. Of the total births, 1.9% (95% CI 1.3–2.5) were reportedly delivered by cesarean and 0.4% (9/2,316) with instrumental delivery. There were 53 reported maternal deaths in the 12 months before the survey, resulting in a maternal mortality rate of 1,600 per 100,000 females per year. Of the maternal deaths, 30 females (56.6%) did not receive any type of modern health care with 53% (16/30) of families citing financial constraints.

CONCLUSION: This study reaffirms a low family planning uptake and very low instrument deliveries and cesarean delivery rates in Sierra Leone. Additionally, financial barriers hinder access to health care and indicate that the free health care initiative for pregnant females is not yet fully covering the reproductive needs of the females of Sierra Leone.


A full-country community survey in Sierra Leone estimates a maternal mortality rate of 1,600 per 100,000 females per year and a contraception use rate of 20%.

Surgeons OverSeas and the Department of Surgery, Columbia University, New York, New York; the Department of Gynecology and Obstetrics, Johns Hopkins Hospital, and the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; the College of Medicine and Allied Health Sciences (COMAHS), the Department of Surgery, Connaught Hospital, and the University of Sierra Leone, Freetown, Sierra Leone; the Epidemiology Division, Medical College of Wisconsin, Milwaukee, Wisconsin; the Royal Tropical Institute (KIT), Amsterdam, and the Department of Obstetrics and Gynecology, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands; and the Department of Obstetrics and Gynecology at CSI Kalyani Multispecialty Hospital, Chennai, India.

Corresponding author: Reinou S. Groen, MD, MIH, Johns Hopkins Hospital, Department Gynecology and Obstetrics, 600 North Wolfestreet, Phipps 279 Baltimore, MD; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

Funded by Surgeons OverSeas with a donation from the Thompson Family Foundation. The Sierra Leone Ministry of Health & Sanitation, College of Medicine and Allied Health Sciences and Connaught Hospital assisted with administrative support.

The authors thank Sahr Yambasu, MS, from Statistics Sierra Leone, for random assignment of the clusters, availability of the maps, and directions of the clusters.

Presented at the American College of Obstetricians and Gynecologists Residents District Meeting, Baltimore, Maryland, April 12, 2013.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.