The West African nation of Sierra Leone has the second-highest child mortality rate in the world. A recent survey by Sierra Leonean health authorities, UNICEF and the World Health Organization found that more than one out of four children die before their fifth birthday.

Other reports indicate that very few women receive pre-natal care from trained practitioners like doctors, nurses or midwives. Sierra Leone does not have a standard pre-natal care package, so there are no records on how many women get basic services,

The World Health Organization says the death rate among newborns in Sierra Leone is above the average for Africa, at 56 per 1,000 live births.

Doctors in government hospitals blame traditional birth attendants for the high death rate. They say most women are brought to the hospital too late, having relied on the attendants, who do not have the training and tools to take care of high-risk pregnancies. Most of these mothers and babies die before they can get medical care.

But the attendants say they have a major role to play, especially in a country where poverty, poor transportation and cultural practices keep many women from going to the hospital.

The attendants say most women in rural areas, where there are no hospitals, see the traditional birth attendants as crucial because up to 70 percent of all births take place at home.