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Greater investment needed in SRHR to end preventable deaths of mothers and children

Friday 04 September 2020 Ufuoma Omo-Obi Maternal health Sierra Leone

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Over the past decades the UK has been a leader in reducing global poverty and UK Aid has greatly contributed to the reduction of preventable maternal and child deaths through its focus on access to sexual and reproductive health and rights.

We were delighted to see Boris Johnson’s government reaffirming its previous commitment to ending preventable deaths of mothers, new-born babies and children by 2030 in the election manifesto - as the new UK Aid-funded study by the Guttmacher Institute, Adding It Up, shows us, additional investments are still needed to achieve this goal.

Brave and forward-thinking global leadership and targeted financial investment from the UK government has been delivering measurable and meaningful results that are preventing the needless deaths of thousands of women and girls. For example, in the first 18 months of the UK-funded flagship WISH programme, which covers 12 countries in West and Central Africa, the programme has averted an estimated 2.6 million unintended pregnancies, 1.1 million unsafe abortions, and 13,000 maternal deaths.

We know that investing in access to modern contraception, safe abortion, and post-abortion care services saves not only the lives of women and girls, but their children too.

Christiana’s Story

With support from UK Aid, one of the women MSI has supported in Sierra Leone is Christiana. Christiana already had two young children and was preparing to start university when she realised she was pregnant. She knew she didn’t want and couldn’t afford another pregnancy, but the legal restrictions and high levels of stigma drove her to seek an unsafe abortion in secret. When she got home following the procedure, she realised something was wrong.

She suffered in silence overnight as she bled heavily and experienced crippling pains, but when the pain became so unbearable that she thought she might die, she snuck away and went to the nearest Marie Stopes Sierra Leone clinic. She knew they offered treatment for complications caused by unsafe abortion (post-abortion care) from adverts she’d heard on the radio. A Marie Stopes Sierra Leone doctor examined her and realised she had a perforated uterus – untreated, this would have killed her.

Following her life-saving post-abortion care treatment, Christiana was counselled on contraceptive options, and chose to begin using injectable contraceptives, which she has continued to use ever since.

Christiana describes what happened to her as a life changing experience. “It was during this time that I realised contraceptives are the only way for a woman to pursue her dream without the interruption of an unplanned pregnancy. Since then I have taken contraception very seriously. I am always protected.”

Christiana is now a teacher and is taking care of her children in the security that she is protected from unplanned pregnancies.

Access to sexual and reproductive healthcare saves lives

Over half of the 69 million abortions that will occur in low- and middle-income countries this year (approx. 35 million) will be unsafe. As a result, an estimated 7 million women and girls will be treated for devastating injuries and tens of thousands will die. As the World Health Organization has made clear, almost every single one of these deaths could be prevented.

For the women who face injuries, many of these complications will impact their health, well-being and fertility for decades to come and the impact on health systems is severe. The annual cost of providing post-abortion care in low- and middle-income countries is an estimated US$1.7 billion.

Whether abortion is highly restricted or available on request, a woman’s likelihood of seeking an abortion is roughly the same. But legal restrictions, along with other barriers, mean many women induce abortion themselves or seek an abortion from unsafe providers. What makes the current situation even more unacceptable is that deaths and complications due to unsafe abortion are entirely preventable – no woman or girl should die for the right to determine her own future.

Access to modern contraception is also limited. In their new Adding It Up report, Guttmacher estimated that 218 million women want to prevent a pregnancy but aren’t accessing a modern method of contraception. If their contraceptive needs were met, there would be 26 million fewer unsafe abortions and 70,000 fewer maternal deaths every year. Investing in contraception is a cost-effective solution – for each additional dollar spent on contraceptive services, the cost of pregnancy-related care drops by three dollars. This investment would not only reduce preventable deaths but improve educational and economic opportunities for women and girls, reduce poverty and decrease dependence on international aid.

There is a severe lack of access to sexual and reproductive health services for adolescent girls in particular. The Adding It Up study found that the unmet need for modern contraception is disproportionately high among adolescents aged 15-19; 43% want to avoid pregnancy but lack access to contraception (compared to 24% of women between 15-49). For this age group, pregnancy and childbirth complications are the leading cause of death globally and young women and girls (aged 15-24) account for nearly one-third of unsafe abortion-related deaths. With a tailored adolescent strategy, which has allowed MSI to reach 3.5 million adolescents since 2017, MSI is supporting the UK Government to realise a future where no girl or young woman dies from an unsafe abortion or preventable maternal death.

We know that the FCDO has tough decisions to make about how they will prioritise and spend their aid budget moving forward, and that these must align with the strategic aims agreed through the Integrated Review. Our experience working in some of the countries with the highest rates of poverty every day shows us that investing in sexual and reproductive healthcare is one of the most cost-effective ways to fulfil the government’s commitments to preventing maternal and child deaths. But beyond this, it is also a key contributor to a series of other strategic goals around gender equality, economic development, and resilience strengthening.

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