Human Rights Watch (HRW) has unveiled alarming details about the state of maternal care in Sierra Leone, revealing a disturbing pattern of obstetric violence. Despite government efforts to provide free maternal health care, many women still face severe discrimination and abuse during childbirth.

The 80-page report titled "No Money, No Care: Obstetric Violence in Sierra Leone," is based on interviews with over 50 women who encountered health complications due to delayed or denied medical attention, which was contingent on their ability to make informal payments. Shockingly, even in emergencies, some women were left untreated or faced significant delays because they couldn't pay.

Launched in 2010, Sierra Leone's free healthcare initiative aimed to curb the world's highest maternal mortality rates. However, HRW's findings indicate that the reality is far from the policy's intent. Informal payments are still a pervasive barrier to receiving proper care, often determining the speed and quality of the treatment women receive in public healthcare facilities.

Obstetric violence, as outlined by HRW, includes a range of abuses from non-consensual medical interventions and verbal abuse to neglect and the denial of pain relief during labor. Such practices not only violate women's rights but also their dignity and bodily autonomy.

In response, HRW has urged the Sierra Leonean government to recognize obstetric violence as a severe human rights violation. They recommend increased regulation and oversight of maternal health services, more paid staffing, ensuring availability of essential medical supplies, and a systematic reduction in out-of-pocket expenditures for patients.

Despite these challenges, Sierra Leone has made notable advances in women's rights, including decriminalizing abortion in 2022 and criminalizing child marriage in 2024. Yet, the persistence of high maternal mortality rates underscores the urgent need for comprehensive reforms in maternal healthcare practices.

HRW's report not only highlights the critical issues at stake but also serves as a call to action for Sierra Leone to safeguard the health and rights of all women, ensuring that childbirth remains a safe and dignified experience.