Obstetric Violence Threatens Lives of Sierra Leonean Women and Newborns
By Sahr Ibrahim Komba (232news)
A new report by Human Rights Watch, in collaboration with Amnesty International Sierra Leone, has uncovered alarming cases of neglect, abuse, and corruption in Sierra Leone’s public maternity hospitals, revealing that women and newborns are losing their lives due to the inability to pay informal fees demanded by health workers.
The report, titled “No Money, No Care: Obstetric Violence in Sierra Leone,” exposes a disturbing pattern of mistreatment of women during childbirth, including verbal abuse, medical neglect, and abandonment. The findings highlight a deep crisis in maternal healthcare delivery that undermines Sierra Leone’s Free Health Care Initiative for pregnant women and children under five.
The report was launched in November 3,2025 at the CCSL Boardroom Kinghaman Road.
According to the report, women giving birth in public hospitals often face shame, long waits, untreated pain, and even death when they cannot afford informal fees. Many women interviewed said they were ignored or mistreated by healthcare workers, denied essential care, or subjected to abusive treatment.
“Women giving birth in some government hospitals face shame, long waits, untreated pain, and even risk losing their or their newborn’s lives,” said Skye Wheeler, Senior Women’s Rights Researcher at Human Rights Watch. “Sierra Leone’s government is failing to address harmful practices in its public health care system, leaving providers to extract money from extremely vulnerable patients.”
The report describes obstetric violence the abuse or mistreatment of women during childbirth as a pervasive but underrecognized form of gender-based violence. It includes forced medical procedures, neglect, and denial of pain medication, often carried out without the patient’s consent.
The investigation cites several harrowing accounts from patients at the Princess Christian Maternity Hospital (PCMH) in Freetown, the country’s main obstetric facility.
One mother, who lost her baby shortly after birth, said hospital staff ignored her because she could not pay for soap and plastic sheeting. “They only focused on the ones who had money,” she said. “Because I lacked money, I had to suffer. I was abandoned for two hours while my husband went to borrow money. When the midwife finally came, the baby cried once and died.”
Another woman described waiting three days for treatment, sleeping on the hospital floor before being attended to. By the time doctors performed surgery, her baby had already died. “The doctor was angry,” she recalled. “He said it was the fault of PCMH that my baby died.”
The report found that informal payments often indistinguishable from bribes determine the quality and speed of care women receive. These fees, demanded even during life-threatening emergencies, have left many families financially devastated and grieving.
“Many hospital workers are unpaid or underpaid, which drives them to solicit money from patients,” Wheeler explained. “But this practice has deadly consequences. Women are dying because care is delayed until payment is made.”
Despite government commitments to maternal health, Sierra Leone continues to record one of the highest maternal and child mortality rates in the world. The Free Health Care Initiative, launched in 2010, was meant to guarantee free care for pregnant women and children under five. However, many families report paying for every aspect of treatment. Some healthcare workers and patients described the initiative as a “ghost” or “mirage.”
Madam Wheeler urged the government to urgently increase funding for healthcare facilities, pay staff salaries regularly, and ensure hospitals are equipped with essential medicines. She also called for a functional complaints and accountability system to address mistreatment in hospitals.
“Sierra Leone has made progress in recognizing respectful maternity care,” Wheeler said, “but without strong financial investment and oversight, women will continue to die needlessly.”
The report concludes that up to 50 percent of Sierra Leone’s public healthcare workers are unpaid volunteers, while most health facilities face severe shortages of drugs and supplies forcing both staff and patients into desperate measures.
Speaking at the launch, Solomon Sogbadi, Country Director for Amnesty International Sierra Leone, said that births in government-run hospitals have increased since the introduction of the Free Health Care policy and the criminalization of traditional birth attendants. However, he noted significant challenges in supervision and the quality of healthcare services.
Sogbadi revealed that the Free Health Care Initiative is 75 percent funded by development partners, raising concerns about sustainability. “If the government cannot adequately fund the health sector now, what will happen when donor partners withdraw their support?” he asked.
He further highlighted issues of corruption, noting persistent reports of free healthcare drugs being stolen from government hospitals. “Many patients have lost their lives in public hospitals, and no one has been held accountable. Many of these deaths result from negligence by service providers,” he said.
Sogbadi pointed to the Medical Examination Act of 2021, which mandates investigations into deaths occurring in medical facilities, especially those linked to neglect. “Nothing has been done since the enactment of this law,” he lamented. He also emphasized that free healthcare drugs are basic and often inadequate for pregnant women and children, forcing them to spend out-of-pocket.
He disclosed that some hospital staff run what he called “mobile pharmacies,” directing patients to private outlets where they must purchase prescribed drugs. “This system shows the depth of corruption within public hospitals,” he said.
Both Human Rights Watch and Amnesty International called on the government to take urgent action to reform the health sector, address systemic corruption, and ensure that no woman or newborn dies because they cannot afford care.
