By Desmond Lewis
Sierra Leone – November 3, 2025: A new report released by Human Rights Watch has revealed alarming levels of abuse, neglect, and mistreatment of women giving birth in public hospitals across Sierra Leone, particularly those unable to pay informal fees. The 75-page report, titled “No Money, No Care: Obstetric Violence in Sierra Leone,” documents widespread violations of women’s rights in maternity care settings, including cases that have led to the deaths of mothers and newborns.
The report highlights how Sierra Leone’s maternal healthcare system—despite notable progress in reducing maternal mortality—is being undermined by chronic underfunding, reliance on unpaid volunteer staff, and systemic corruption. These conditions have created an environment where women in labor are routinely subjected to verbal abuse, medical neglect, and abandonment, especially when they cannot afford to pay hospital staff.
💔 Harrowing Testimonies of Abuse
Human Rights Watch interviewed over 50 postpartum women and 50 healthcare providers. Many women recounted being shamed for expressing pain or needing assistance, while others described being ignored or denied care due to their inability to pay. One woman shared how her newborn died after she was left unattended for two hours during labor because she lacked money for basic supplies like soap and plastic sheeting.
Another woman waited nearly three days for treatment at Princess Christian Maternity Hospital (PCMH), Sierra Leone’s primary obstetric facility. By the time she was seen, her baby had died. “He said it was the fault of PCMH that my baby died,” she recalled the doctor saying.
Healthcare providers confirmed that delays and denials of care due to financial constraints are common, often resulting in preventable deaths and complications. Many facilities lack essential drugs and equipment, forcing patients to purchase supplies directly from staff.
Obstetric Violence: A Hidden Crisis
Obstetric violence—a form of gender-based violence—includes a spectrum of abuses such as forced medical procedures, denial of pain relief, verbal humiliation, and physical restraint during childbirth. Though globally pervasive, it remains underrecognized and largely unaddressed in Sierra Leone.
Skye Wheeler, senior women’s rights researcher at Human Rights Watch, stated:
“Women giving birth in some government hospitals face shame, long waits, untreated pain, and suffering, and even risk losing their or their newborn’s lives. Sierra Leone’s government is failing to address harmful practices in its public health care system, leaving providers to resort to extracting money from extremely vulnerable patients.”
Systemic Failures Undermine Free Health Care
Sierra Leone’s Free Health Care Initiative, launched in 2010, promises free services for pregnant and lactating women and children under five. However, women interviewed said they paid for nearly every aspect of their care, describing the initiative as a “ghost” or “mirage.”
Human Rights Watch found that up to 50 percent of public healthcare workers are unpaid volunteers, and facilities face severe shortages of basic medical commodities. These gaps force staff to solicit payments from patients, often under coercive conditions.
Maternal and Child Mortality Remain High
Despite a 70 percent decline in maternal mortality between 2013 and 2023, Sierra Leone still ranks among the countries with the highest under-five mortality rates globally. Experts warn that without urgent reforms, these gains could be reversed.
Recommendations for Reform
Human Rights Watch is calling on the government to:
- Increase funding for public healthcare facilities
- Hire and pay more qualified staff
- Ensure consistent supply of essential drugs and equipment
- Establish accessible complaints and compensation mechanisms
- Publicly acknowledge obstetric violence as a human rights issue
The report also urges international institutions to ensure that Sierra Leone’s debt obligations do not hinder its ability to invest in maternal and newborn healthcare.
A Call for Accountability
While some healthcare providers noted improvements following training on respectful maternity care, the report emphasizes that systemic change is needed. The Anti-Corruption Commission has taken steps to address medical corruption, but enforcement remains inconsistent.
Human Rights Watch concludes that Sierra Leone must listen to the voices of affected women and take concrete steps to eliminate obstetric violence and uphold the right to health.
“Without action, Sierra Leone’s significant progress in reducing maternal deaths is at risk,” Wheeler said. “But this is not just about public health statistics. The government should listen to the stories and experiences of women and recognize how obstetric violence has caused deep harm to girls and women’s rights.”