Fighting maternal mortality in the Gambia

In a tiny barren village somewhere in Gambia, a woman is in labor but there are complications. Although health workers are present, none of them are qualified to provide emergency obstetrics care, meaning the woman will have to be transported to a larger hospital farther away from her location. Although maternal mortality is statistically on the decline, the Gambia remains one of the top ten countries in the world where it is most dangerous to become a mother.

Women in the Gambia are highly fertile however, many of them live under the national poverty line. Most women give birth to more than five children in their lifetime and lack of sexual education and birth planning makes each subsequent pregnancy more dangerous than the last. Last year alone, maternal mortality rates stood at 433 deaths per 100,000 live births (World Health Organization). CEO of Save the Children Carolyn Miles stresses that “conditions for mothers and their children in the bottom countries are grim, as nations struggle to provide the basic infrastructure for the health and wellness of their citizens”. Women living in remote and rural areas often lack the most basic tools for a medically sound delivery, such as clean water and cotton gauze.

What then are the main factors behind maternal mortality? Quality of care and availability of health services top the list. The primary cause of maternal deaths are delays in transporting women to health care facilities. In Gambia, a three-tier healthcare system separates rural clinics from basic clinics and major hospitals. The primary level consists of village health services, community health workers, and traditional birth attendants. The secondary level is made up of basic health clinics and facilities, and the tertiary level includes all major health centers and hospitals, as well as special privately-owned institutes or NGO-run institutes. In Gambia, only hospitals are qualified to provide emergency obstetrics care, meaning that women experiencing complications must be transported to a major hospital immediately.

A decline in health workers has resulted in longer wait times at clinics, further increasing the delay in treatment. Currently, the average wait time at a clinic is 68 minutes, but this wait time only occurs when the clinic is adequately staffed. The ratio of doctors to patients is 1:1964, and the ratio of nurses to patients is 1:5614, which shows the apparent need for medical professionals. Expectant women are denied necessary antenatal and postnatal care, and many women avoid clinics altogether, choosing to give birth at home instead, where they won’t have to wait in line for a doctor.

There are needless and life-threatening delays in Gambia’s healthcare system that transform the process of birth into a fatal, feared one. Considering the great shortage in trained medical professionals at the smaller regional healthcare centers, increased spending on training healthcare workers would yield long-term benefits for women. Establishing a healthcare system that functions adequately in rural areas as well as urban areas, would decrease treatment delays and grant more women access to lifesaving prenatal and postnatal care.

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