One of the many major gendered issues in Sierra Leone is the high number of maternal deaths.  Sierra Leone has the second highest in the world with 2100 per 100,000 of live births. The highest is Rwanda with 2300 maternal deaths.  The lack of access to reproductive health care services is a leading factor in maternal mortality.  Only 30 percent of women received prenatal care in Sierra Leone as of 1996 and even fewer (25%percent) of the deliveries attended by skilled attendants (The World’s Women/United Nations, 2000). The lack of prenatal care, health care facilities, and skilled birthing providers are major factors.  Many utilize midwives in the rural areas and throughout Sierra Leone; therefore, the birthing facilities and tools may not be disinfected or cleaned properly, possibly leading to infection or complications that could result in death or last for the woman’s lifetime.  Prenatal care and proper delivery services are seen to be major components in reducing maternal mortality.  In Africa, the United Nations Children Fund (UNICEF) and the World Health Organization (WHO) estimate that women's lifetime risk of dying from maternal causes is 1 in 16; meanwhile, in Europe, it is only 1 in 1,400.  This is a tremendous difference, and a powerful differentiating factor in the lives of women in the Global North and Global South.