Mattru Jong — Emmanuel is a male midwife.
At the age of 26, he lives and works on one of eight islands off the southwest peninsular of Sierra Leone, an hour by speedboat from Mattru Jong, the capital of Bonthe District.
On a particularly hot Wednesday morning, IPS joins Marie Stopes, United Nations Population Fund (UNFPA) and Sierra Leone's Ministry of Health to go and visit a population on one of the Turtle Islands that is practically untouched by modern civilisation.
Marie Stopes is a British-based non-profit that provides family planning and reproductive health services to over 30 countries around the world. They work as a back-up support system to the government, filling in the gaps in hard-to-reach areas that the government is still working to resource.
On the mainland of Mattru Jong there is a small market, situated on the river Jong which flows into the Atlantic ocean, and crowded with various kiosks boasting fish, vegetables and live chickens tied at their feet in straw baskets.
To reach the islands, one has to travel by boat. But all the islands don't have landing docks and the boats sometimes stop in knee-deep water. Passengers - and midwives visiting the islands to provide reproductive health and family planning services - have to hoist their belongings and supplies above water, to make their way to the villages.
"Their [midwives] challenge is that they don't have a boat. If you want to do this effectively, you need a good boat," Safiatu Foday, a regional family planning coordinator for UNFPA in Sierra Leone, explained to IPS.
For island communities that have very little access to the mainland, basic health information is difficult to come by, therefore the risks - especially those pertaining to pregnancy, become inevitable.
With a population of over six million, where women of childbearing age are between the ages of 15 and 49, this West African country has refocused its health initiatives, working tirelessly to strengthen the capacity and training of skilled midwives - an exceptional tool in reducing maternal and infant mortality.
It Takes a Village
The village is inhabited by about a few hundred people - most of them large families, many of whom have just started utilising the peripheral health unit (PHU) that is onsite.
Emmanuel, one of the first men to undertake the position of midwife in this area, is the person "in-charge," facilitating prenatal visits, deliveries, antenatal care, attending to illnesses and referring patients to a hospital when needed.
"There are people who since their birth, have never left the island," Fadoy said.
Some of the women say they have delivered 13 or 14 children prior to the work of Marie Stopes in their village.
Others recount having no time to "rest" or take care of their other children while being pregnant almost every year.
There are common reasons as to why women become pregnant so consistently.
One woman shares that there is a fear of being "abandoned" by one's husband. The women say if they do not engage in sexual intercourse during the marriage, their husbands will look elsewhere. Therefore women feel they have no choice but to keep getting pregnant.
There is also the question of approval; many women must obtain permission from their husbands to start using contraceptives.
"We used to get pregnant all the time and our husbands would abandon us, so we had to fight for ourselves to survive. Since Marie Stopes came to the island and we now have access to contraceptives, we are able to take care of ourselves," Yeanga, 33 tells IPS, adding, "It has created an impact in my life, one, because I now know about spacing births."
Yeanga is the mother of five children with the oldest aged 25, and the youngest only three years old.
Before going on family planning, Yeanga admits to having difficulties with her husband, which were only heightened when he found out that contraceptives would help her not to get pregnant.
"Even when I wanted to join family planning, my husband was not agreeing, but I talked to him about it and we finally agreed to allow me to start family planning."
In order to fully meet the demand of women who are in search of family planning and reproductive health services, the government has come up with an interesting strategy: recruit and train traditional birth attendants (TBA's) to provide quality health care services in the villages.
Because they are from the village, they are both respected and valued, thus their insight, advice and knowledge are taken very seriously.
"Before midwives came to the island, there were just TBA's doing deliveries in this area - and there were a lot of problems with these births," Isatu Jalloh, 28, a nurse working in the village, told IPS.
Without skilled birth attendants, many of the women on the island suffered complications like preeclampsia, fistula and even death.
Though Sierra Leone has one of the highest maternal and infant mortality rates, 140 infant deaths per 1,000 live births, and 857 maternal deaths per 100,000 live births, Jalloh believes that the maternal death rate on the island has reduced due to the advocacy of midwives who travel to the island to promote family planning and reproductive health.
The ability to choose when to have children has allowed women on the island to pursue small economic ventures. They are able to produce an income to not only take care of themselves, but also their children.
The Future is Bright?
As the last few hundred days of the United Nations Millennium Development Goals (MDGs) come to a close, Sierra Leone stands at an interesting cross section: that of incremental success and challenges to come.
Demand for reproductive health and family planning services is high, the commodities are being supplied through partnerships with UNFPA and Marie Stopes, midwives are being dispatched to different districts, yet obstacles remain.
Most trained midwives deployed to health centres far from their homes don't want to stay in those areas due to harsh working conditions and unfamiliarity with their surroundings.
And with the outbreak of Ebola, most midwives have been immediately evacuated, leaving patients, many of them pregnant women, without proper care.
Sierra Leone faces an opportunity to scale-up its reproductive health and family planning services by continuing its ability for form essential partnerships, most effectively illustrated in the one with civil society and advocacy group, Health Coalition for All.
"Our focus is on health and health-related issues. The key areas are advocacy and monitory, we work to ensure that services are available, accessible, affordable and that they reach the beneficiary," Al Hassane B. Kamara, a programme manager for the coalition, shared with IPS.
Based in Makeni, in Northern Province, the Health Coalition for All has played an essential role in ensuring that women have access to healthcare, especially during pregnancy.
By addressing the issues such as lack of trained staff, delivery of commodities and most importantly, the high user fees during clinic visits, the coalition takes a proactive stand to ensure that women do not end up in unqualified hands.
"They pay very high fees to see a qualified doctor, especially for cesarean operations. As a result they have no options but to work with the TBA or a "quack doctor."
With programmes such as the Free Health Care Initiative (FHCI) that allows pregnant mothers, lactating mothers and children under the age of five to access services for free, Sierra Leone continues to put its focus on reproductive health.
Edited by: Nalisha Adams
The writer can be contacted through Twitter on: @Erakit