The Princess of Safe Motherhood

The Princess of Safe Motherhood

Publication info

Carol Meyer

Five years have passed, but the pain on Neneh Mansaray’s face tells more of the story than the monotone words that escape from her trembling lips. It is heartbreaking and uncomfortable to watch as she vividly remembers the struggles of her past. Taking notes seems insensitive. Yet Neneh assures us that her story must be told. This petite and unassuming woman is fiercely determined. From tragedy she has garnered her own triumph, and now it’s her goal to make sure that other women in Sierra Leone do not suffer the hardship she has faced. With CARE, Neneh is helping women in her village focus on the joy she has come to know - motherhood.

At the age of 18, Neneh gave birth prematurely to a stillborn child. Trying desperately to start the family she knew she was meant to have, a civil war and the death of her husband seemed to thwart her chances for success. She later remarried and tried repeatedly to get pregnant. Eventually she did conceive and carried the child to term.

But for many women in developing countries, carrying a child to term does not always lead to motherhood.

In Sierra Leone, one out of every 56 live births results in the death of the mother. According to the United Nations Human Development Index, it is the poorest country in the world, ranking number 177 – the very bottom of the list – adding to the challenges women face.

Neneh’s delivery was a harrowing experience, and at this point she can’t even look at us as she proceeds to tell us about it. Her eyes stare off in the distance, taking her deep into a painful past.

Neneh lived in a small farm community. She moved there when she married her second husband. When it came time to finally deliver their first child, a recent death in the community added to the already difficult task of giving birth at home. She labored for days, but the unborn child did not come quickly. The women of the village who assisted with deliveries were called off with the men to attend to the remains of their deceased neighbor, a customary practice in Sierra Leone. Without a health facility in the community, Neneh continued to push through her labor alone.

Finally, the child crowned, but no one was around to assist Neneh. She couldn’t stand; her feet had swollen so much from the stress placed on her tiny body. Upon returning, the women of the  village discovered that Neneh had labored for seven days only to once again give birth to a stillborn baby. Yet the labor was not over. The placenta remained inside of her and she struggled to deliver it. The women pushed on Neneh’s stomach, hoping to coax it along. They reached inside her, attempting to rid her body of the last bits of afterbirth.

I thought I was going to die.

- Neneh


Urine seeped out of her uncontrollably. After 10 days of relentless labor, she finally passed the placenta. Not surprisingly, she was lethargic.

When a woman from Neneh’s parents’ village came to check on Neneh, her neighbors panicked. They wanted to hide Neneh because they believed they had contributed to her demise. So Neneh retreated to a nearby field – alone – left to die. Scared and weak, she spent the night outside, exhausted from the 10 days of intensive labor and bleeding. Word traveled back to Neneh’s parents and her elder sister Fatu arrived from Yataya village to recover her from the bush.

Neneh’s own community refused to help her, claiming they had no stretcher to help transport her and chastising her for being unable to deliver her own child.

Neneh and Fatu had few options. Neneh could not walk - she was bleeding and urinating, and partial paralysis had set in. In her mind, Neneh had given up on life. Once again, she was left alone by the bank of a river while her sister went to gather members from her community to recover Neneh and bring her back to Yataya.

For reasons she cannot explain, Neneh’s weakened and frail body clung to life. Once she arrived in her sister’s village, Princess, a local health worker, contacted CARE and helped call for an ambulance. Neneh was brought to a hospital in the nearby city of Kabala, about a 25-minute drive from Yataya, where doctors saved her life.

Afterwards, Neneh returned to Yataya instead of her husband’s community. He blamed her for their inability to have children and the entire community felt she was cursed. But life wasn’t much better in Yataya. Because of the prolonged and stressful labor, Neneh had developed an obstetric fistula, or a small tear in her bladder wall. She could no longer control her urine, causing an unavoidable foul odor.

When she went to gather water, the women would call her names and refused to let her have access to the pump. Men and women would gather on the front porch of her sister’s home to verbally abuse her. Neneh spent her days sneaking out the back door of her sister’s home in the early morning and returning late at night after dark, to escape the hurtful criticism. She was confused and didn’t know why she could not control her bladder. Ashamed, she sat under a tree each day to pass the daylight hours alone. She couldn’t do chores because the community banned her from public places, calling her “dirty.” They spread rumors that Neneh had developed her condition because she was promiscuous and chased men while she was pregnant. It wounded Neneh to feel the ostracism of yet another community.

When Princess learned of Neneh’s condition, she knew something had to be done. Once again, she approached CARE and together they arranged for Neneh to meet with a local health organization that provides services to people who cannot afford them. They arranged for Neneh to have an operation to fix the fistula and paid all of the expenses.

Neneh returned to Yataya a literally changed woman. Men began to take notice of her. They came to her sister’s house attempting to court her. Finally, as she tells this part of the story, a tear breaks free from her eye.

"When I was sick, people made fun of me. Now, they wanted to marry me."

Princess Lahai and Neneh Mansaray stand under a tree next to Neneh's home in the community of Kamanso.  Princess works for CARE as a Community Health Mobilizer under the Child Survival Project.  She is proud to stand with her friend Neneh because she was very involved in Neneh's recovery after the miscarriage of her second child which lead to a fistula.  Princess helped Neneh get the healthcare she needed to make it possible to have another baby, Kolleh K.

But then a slight smile cracks her lips apart and she says, “So I told them all, ‘No.’” Instead, Neneh joined a local health club formed by her friend Princess, who now works for CARE.

She became involved in her community and wanted to learn about her own health and how she could prevent things like the fistula from happening again. In the health club, Neneh learned about water and sanitation, malaria prevention, birth preparedness and the benefits of exclusive breastfeeding. In all, she completed 25 health topics and earned a certificate to become a community health promoter. She now shares her knowledge with other families in her village.

Attending community health club meetings gave Neneh a confidence she never had. Osman, the village chief from a nearby community, noticed Neneh as he came to Yataya on business each week and he began to pursue her. Eventually they married, but Neneh was still nervous about becoming pregnant. She worried that pregnancy was the cause of her obstetric fistula, so she consulted with the local health organization that helped her obtain the fistula operation.

There, they advised her to give birth at the hospital, where she would have access to proper medical treatment in the case of another difficult delivery. Neneh also joined her local pregnancy support group organized by CARE, where she and other women learned about proper nutrition and prenatal care such as vaccinations and malaria prevention.

Today, Neneh has a healthy little boy named Kolleh. She is grateful to CARE for helping her achieve her dream of motherhood; she credits CARE with enlightening her to health issues and how to recognize complications from pregnancy before it is too late. “I would have died if I never came into contact with CARE,” she says. “Without CARE and Princess, I would not have been able to get the operation and I would not be here.”



CARE is teaching people what to do so they will do it for themselves and have a better life.



Neneh Mansaray feeds her son Kolleh K Kargbo under a tree in her village Kamanso. Neneh is a community health club member and growth promoter involved with CARE's Child Survival project. All images: © 2008 Sarah Blizzard/CARE