Amnesty International is warning of a "human rights emergency" in Sierra Leone, which has one of the highest maternal and child mortality rates in the world. One in eight women in the west African country risk dying during pregnancy or childbirth, compared with one in 4,500 in the developed world, an Amnesty report says.
Many women and girls are too poor to pay for lifesaving treatment, the report adds. Thousands bleed to death after giving birth. Most die in their homes. Some die on the way to hospital - in taxis, on motorbikes or on foot. Less than half of deliveries are attended by a skilled birth attendant and fewer than one in five are carried out in health facilities.
"These grim statistics reveal maternal deaths are a human rights emergency in Sierra Leone," said Irene Khan, Amnesty's secretary general, launching the report in Sierra Leone's capital, Freetown. "Women and girls are dying in their thousands because they are routinely denied their right to life and health, in spite of promises from the government to provide free healthcare to all pregnant women."
Women in poor rural areas are particularly vulnerable, due to a lack of transport and infrastructure. Campaigners say that the issue is partly a legacy of the country's 11-year civil war. Abigail Renner, of Women in Peace Building in Sierra Leone, said: "We are a postwar country. The cost of living is very high, the roads are bad, drugs are very expensive and we don't have enough hospitals." She added: "Before the war, women were not afraid to have children. Now they are."
The Amnesty campaign coincides with tomorrow's United Nations general assembly meeting, where Gordon Brown is expected to announce finance packages to provide free healthcare for millions more women and children in the developing world, including Sierra Leone.
Amnesty's research found the difficulties experienced by women in Sierra Leone were exacerbated by women's low status in society, the fact that many girls marry and become pregnant at a young age, and the ongoing practice of female genital mutilation. Women's health is often treated as a low priority.
Gareth Thomas, Britain's international development minister, who is visiting the country this week, said: "There has got to be a huge change in the way that women are seen in Sierra Leone. The numbers of women raped and killed during the conflict partly reflects a culture where they are far from equal."
Thomas said postwar improvements in governance should now be matched by basic services. Britain will put £16m into a healthcare plan, working with Unicef and other non-government organisations. "In the 21st century it is unacceptable for people to die because they are too poor to see a doctor or nurse," the minister added.