By Alvin Lansana Kargbo

Human Rights Watch has released a 75-page investigative report exposing widespread obstetric violence, neglect and informal payments in Sierra Leone’s public hospitals. The report, titled “No Money, No Care: Obstetric Violence in Sierra Leone,” details systemic mistreatment of women during childbirth and warns that preventable maternal and newborn deaths persist due to corruption, poor accountability and a lack of essential medical resources.

At a press conference held on Monday, 3rd November, 2025 at the Council of Churches in Sierra Leone (CCSL) Hall, Brookfields in Freetown, Human Rights Watch presented its findings and recommendations aimed at strengthening maternal health rights and improving reproductive healthcare delivery across the country. Amnesty International Sierra Leone echoed the call for reform and shared updates on its ongoing programmatic and research work on maternal health rights.

Presenting the report, Skye Wheeler, Senior Researcher in the Women’s Rights Division at Human Rights Watch, said obstetric violence, including verbal abuse, denial of treatment and abandonment of women unable to pay informal fees, constitutes both a public health emergency and a human rights crisis.

She explained that the research, based on more than 150 interviews conducted between 2024 and 2025, revealed widespread mistreatment and systemic failures in Sierra Leone’s public health system. “Women and newborns are dying and suffering preventable injuries because healthcare providers neglect or abandon patients who cannot make informal payments,” Skye Wheeler said.

According to the report, Sierra Leone’s Free Health Care Initiative (FHCI), intended to provide free services for pregnant women, lactating mothers and children under five, has largely failed to meet its objectives. Many women described the initiative as a “ghost” or “mirage,” as nearly all 50 postpartum women interviewed reported paying for some part of their care.

“Women who could not pay were often ignored in hospital corridors, left waiting for hours or denied attention while relatives tried to find money,” Skye Wheeler said, adding that such practices deepen gender inequality and erode trust in the health system.

She urged the Government to take urgent steps to ensure a steady supply of essential medicines and life-saving materials, such as sutures, IV fluids and gloves, and to address the heavy reliance on unpaid volunteer workers, who make up nearly half of the health workforce and often depend on informal payments from patients.

Skye Wheeler also highlighted how gender and economic pressures aggravate the crisis. “Many women depend on male relatives for permission and money to access healthcare. This delays treatment and puts their lives at risk,” she stated.

While acknowledging ongoing Government efforts, such as the Anti-Corruption Commission’s monitoring of maternal health facilities and the near passage of the Safe Motherhood Bill, Skye Wheeler insisted that stronger measures are needed. These include improved health sector funding, training on respectful care and robust systems to ensure accountability and continuous availability of medical supplies.

She also called on international donors to renew commitments to Sierra Leone’s health system and urged the Government to expand its tax base, currently about 11 percent of GDP to support universal health coverage.

Solomon Sogbandi, Country Director of Amnesty International Sierra Leone, welcomed the Human Rights Watch report and noted that while the FHCI has saved many lives since its 2010 introduction, it remains fragile and underfunded.

He recalled that Amnesty International’s 2008 research on maternal health barriers helped prompt the creation of the FHCI but said progress has been uneven. “Maternal mortality has fallen to around 414 per 100,000 live births from over 800 fifteen years ago, but the system remains plagued by corruption, stockouts and illicit payments,” he said.

Solomon Sogbandi pointed out that the FHCI remains a policy rather than a law, leaving it without guaranteed funding or enforceability. He cited weak supervision, poor accountability and persistent corruption as key factors undermining maternal healthcare.

He described disturbing cases where patients were denied treatment or forced to buy essential drugs from informal “mobile pharmacies.” Chronic blood shortages and missing hospital commodities, he said, have pushed families into financial hardship and, in some cases, led to deaths.

“The policy must be strengthened, enshrined in law, properly financed, and free from corruption,” Solomon Sogbandi asserted. “If we fail to care for pregnant women, we undermine every other human capital investment, including education and economic growth.”

He also recounted a tragic case in which a woman died years after a pair of surgical scissors was mistakenly left in her abdomen following an operation in Kenema. “No one has been held accountable,” he said. “This shows the urgent need for stronger medical oversight and legal redress for negligence.”

Solomon Sogbandi questioned how much of Sierra Leone’s 10–11 percent health budget actually benefits reproductive health, warning that donor fatigue and limited domestic financing threaten the sustainability of free healthcare.

He reiterated Amnesty International’s commitment to maternal health advocacy and pledged to collaborate with Government and Civil Society to ensure that policies protect the lives and dignity of women and newborns.

Both Human Rights Watch and Amnesty International called on the Government to prioritize maternal health rights as a national emergency, tackle systemic corruption, ensure consistent supply of essential medicines and formalize the Free Health Care Initiative in law.

The organizations also urged journalists, Civil Society groups and development partners to amplify the findings and support reforms aimed at ending obstetric violence, ensuring that no woman or girl dies giving life because she cannot afford care.