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It’s a special service day in Gbondapi town, Sierra Leone, and that means the long wooden benches in the foyer of the health center are filled exclusively with mothers and their young children. The people outnumber the chairs, so a few perch instead on the concrete ledge surrounding the clinic.

Helen Keller International supports the clinic’s ability to offer weekly service days that give women the opportunity to bring their children for well-baby and well-child visits. In addition to the free medical services they receive—such as vaccinations, drugs, and health screenings—on these special days, they also receive a free hot meal for their children.

A steaming vat of water boils on a small grill next to the clinic wall, fanned by a woman in a black crocheted beret. She calls the women over in small groups and shows them how to mix a few tablespoons of Pikin Mix roasted flour (made from locally sourced sorghum, sesame, and pigeon peas) into cupfuls of boiling water until it forms a thick porridge. In this isolated, rural community where most people struggle to feed their families on less than two dollars a day, a free, hearty meal is a powerful incentive for women to bring their children to the clinic on a regular basis. The cooking demonstration also teaches them how to make the nutritious meal at home.

A nurse in a bright pink uniform calls out names one at a time. Women and children then begin moving through a healthcare conveyor belt of sorts. At the first station, children are weighed in a big plastic tub hanging from ropes affixed to a scale; at the next, they are measured. If these results indicate that a child is malnourished, the nurse refers the child either to an outpatient treatment program with weekly monitoring, or to an inpatient  treatment program if the child has other medical complications and her malnutrition is severe.

After being weighed and measured, the mothers and their children circle back to the nurse’s table, where they learn about optimal infant and young child feeding practices like complementary feeding—that is, nourishing infants from six months to two years of age with solid foods in addition to breastmilk—and how to integrate diverse, nutritious local foods into both the children’s and the mothers’ diets.

The next stop is an exam room, in which a health worker looks through the child’s register, determines the vaccinations, vitamin A supplementation (VAS), deworming and other drugs the child is due for, and administers them accordingly. Well-visits are called “six monthly contact points” because many of the routine services for young children follow a six-month cycle. For example, children receive an oral dose of vitamin A, a crucial micronutrient that strengthens immunity and eye health, twice a year from six months through five years of age. HKI currently supports VAS on a routine basis in seven of Sierra Leone’s 14 districts and will scale up to support the other seven districts over the next year and a half.

Spreading the Message

In Sierra Leone, where vitamin A deficiency is common due to poverty and lack of access to diverse, nutritious food, HKI and its partners have done extensive outreach to educate families about the importance of vitamin A supplements to their children’s health. We spread the message about where and when to get services – and how crucial they are to a child’s well-being –through partners at church and mosque sermons, community meetings, radio programs, videos, posters, flyers, and other methods. “When women in Sierra Leone come to health centers, they ask for vitamin A by name. They appreciate how important it is for their children’s health,” says Helen Keller International Country Director for Sierra Leone, Dr. Mary Hodges.

More women die from causes related to pregnancy and childbirth in Sierra Leone than any other country in the world: it has the highest maternal mortality rate among the 189 countries ranked by the 2018 United Nations Human Development Index. Women in Sierra Leone have, on average, 4.4 children in their lifetimes. More than 86 percent of girls ages 15 to 19 in Sierra Leone have never used contraceptives, and 30 percent of them will have given birth by the time they are 19. Family planning through modern contraception could help women to attain their desired number of children and adequately space their pregnancies, to protect them from health risks and economic strain. The challenge is providing women with quality information about family planning that will allow them to make well-informed decisions about their health.

Helen Keller International’s team in Sierra Leone realized there was an opportunity to offer family planning services to women through our routine VAS distribution services, which already target women of childbearing age. Now, when mothers bring their children to health centers for their twice-yearly vitamin A supplement, they also get comprehensive counseling about birth control options that are available to them free of charge.

Knowledge is Power: Helping Women Make Informed Decisions

The last stop of the well-visit in the Gbondapi health clinic is, in fact, a private session with a specially trained health worker who shows each woman the family planning choices available to her, ranging from daily birth control pills to longer-term injectables to silicone-based implants that work for up to five years.

Janet Moriba benefited from these services. A 17-year-old mother of a baby girl, she dropped out of high school when she became pregnant. (Visibly pregnant girls are not allowed to attend school in Sierra Leone.) Janet wants to re-enroll when her baby is older, and she intends to complete her studies. “I want family planning so I don’t get pregnant again and have another child too quickly. I want to go to school,” she said.

Health worker Veronica Guebio, who took an eight-day family planning training supported by HKI with funding from Irish Aid, patiently explained the pros and cons of each family planning option.

The special training the health workers received allows them to provide family planning services on the spot, at local facilities. It’s an enormous leap forward. “Years back, every two days a woman would die in childbirth, but now it’s different because of better care and family planning,” said Guebio. “So, I feel really good about this work.”

When all was said and done, both Janet and her baby girl left the clinic with the care they needed –vaccinations and vitamin A to help the baby grow healthy and strong, and birth control to help Janet prevent an unplanned pregnancy. It turns out that well-visits for children can help mothers reach their full potential, too.