Four Born Every Second – Saving Lives of Women and Children

Numbers are funny things, aren’t they?


If I said a house I bought a house in London  that cost £287,000, then you would know that it was not a particularly posh area of the city.

If I said I earned a bonus of £287,000 last year, you would think I was a high powered executive (sadly, these two examples are not true)

If I said that Mumsnet clocked up 287,000 page views in around 5 hours, you would imagine that it was quite a popular and influential website


How about this statistic:

Around 287,000 women die every year from pregnancy related causes.

Most of these deaths are preventable, if the women have access to health care.

Whether or not you belong to one of these 287,000 women depends purely on an accident of birth. If you were born in what we term a ‘developed country’, the risk is much lower. Women who live in Sierra Leone, in Burundi, in Cambodia — and even in United States of America — are not so fortunate.

In some African countries, maternal mortality is around 800 deaths per 100,000 births. In comparison, European countries show maternity mortality rates between 4 and 10 deaths per 100,000 births. The US is an anomaly in the developed world, with 16 deaths per 100,000 births.



Getting away from numbers for a moment, lets stop and think about what this means for the individual families.

When the mother dies, the risk of poverty and death to her existing children takes a great leap. They are less likely to go to school, less likely to get a job and escape the grinding poverty into which they were born. Less likely to even reach adulthood.

What are the risks of pregnancy related death, and how can they be prevented? The five leading causes of death during pregnancy are:


Haemorrhage – severe bleeding after the birth

Sepsis – infection during or after delivery, often caused by giving birth in unhygienic environment

Unsafe abortion

Hypertensive Disorders – pre-eclampsia, and eclampsia

Obstructed Labour


In societies with fully functioning health services, most of these conditions or problems would be recognised early enough to prevent loss of life, but what of countries with little  health care facilities?

We are conditioned to think of health care being expensive, but what if we provided emergency obstetric health care in areas of high maternity mortality? Would it make a difference?

The charity Médecins Sans Frontières  decided to find out.

They established two projects, in Sierra Leone and in Burundi. The focus is on emergency care, ie. antenatal care, an emergency transport service and a hospital providing 24/7 treatment of serious pregnancy complications.

At the Gondama Referral Centre in Sierra Leone,  patients are referred from health clinics and midwives in the area when there is a known risk of complications, or when serious complications develop during labour.




The population of Sierra Leone is similar to that of Scotland, around 6 million but they have just 200 doctors, and around 80 midwives. This in a country where only 17% of women use contraception. No wonder they have one of the highest maternal and infant mortality rates in the world.

Trained obstetricians work day and night to save the lives of women who arrive in pain, bleeding, frightened and exhausted. For some of them, the story has a happy ending. For some, despite every effort of the medical team, the women go home without a baby, or don’t go home at all.


The BBC One documentary, which airs at tonight,

at 10.35pm, follows the progress of some of these women


If you missed the programme, you can catch up here on the iPlayer


Bafta winning director Brian Hill has travelled the world to observe the differences in obstetric health care in Sierra Leone, Cambodia, the US and UK. The documentary is as shocking as it is inspirational. It is at times distressing, such as the scenes documenting still birth and the death of a young woman, but it is also incredibly powerful and moving.

Follow the story of Cambodian woman Neang and her 12 year old son Pisey, who has taken on the role of protector of his family. To earn money for his mother and sister, Pisey forgoes schooling to scavenge for rubbish which he sells to buy rice. In a poignant scene, he is filmed picking up HIV meds for his mother while she gives birth to his second baby sister in a nearby hospital. Health care in Cambodia is improving, and they have seen mortality rates sink in the past years.

There are moments of great joy, such as the birth of twins, to the delight of their father, and moments of sorrow when a child is born only to live a few minutes.



And what of the MSF project?

The results are very promising. A estimated reduction of maternal mortality rates by up to 74% shows that the concept of providing emergency care works.

The total annual running costs of these programmes is  around £1.70 per person in Sierra Leone. Yes, you read that number right. One pounds seventy pence per person, per year could save thousands of lives.  This isn’t about state of the art operating theatres or equipment, but very basic health care for those who so desperately need it.

According to MSF:


MSF’s positive experience from
these countries can serve as an encouraging
example for donors, governments and other
NGOs who are considering investing in a
functional and effective referral system and
24/7 emergency obstetric care in countries
where maternal mortality is high and access to
emergency obstetric services is limited.



Watch and share Four Born Every Second, and read about  the MSF project.

Interview with obstetrician Dr Philip de Almeida

More about the series Why Poverty?




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