Female health and family planning in Sierra Leone.
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.


CONCLUSIONS
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.


METHODS
III.
Surgeons OverSeas and the Department of Surgery, Columbia University, New York, New York, USA. rgroen1@jhmi.edu
Reinou S
RS
Groen
Julie
J
Solomon
Mohamed
M
Samai
Thaim B
TB
Kamara
Laura D
LD
Cassidy
Lucie
L
Blok
Adam L
AL
Kushner
Mitra
M
Dhanaraj
Jelle
J
Stekelenburg
D000293:Adolescent; D000328:Adult; D002648:Child; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005193:Family Planning Services / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008427:Maternal Health Services; D008428:Maternal Mortality; D008875:Middle Aged; D011247:Pregnancy; D012807:Sierra Leone / Q000453:epidemiology; D055815:Young Adult