Maternal Mortality – Delays In Transporting Women In Labor To Health Facilities Was The Primary Cause Of Eventual Death
With just over one million inhabitants in about 10,000 square kilometers, the Gambia is a densely populated West African country that has unacceptably high rates of poverty and mortality. With over 60% of the nation living below the poverty line, women experience high rates of fertility, and the population is booming. While the rate of maternal death has been reduced by 46% over the last 20 years, there are still 400 deaths per 100,000 live births in the country ((WHO)). Public expenditure on health remains low, and it is doubtful whether the rate of mortality will see more significant improvement unless a considerable re-investment in women is made ((“The State of the World’s Midwifery,” 2011)).
A recent study examined several cases of maternal mortality in the Gambia, showing that delays in transporting women in labor to health facilities was the primary cause of eventual death. These delays are a result of numerous factors, including previous experiences of maltreatment at health facilities, lack of transportation options, and repeated transfers between clinics and hospitals ((Cham et al., “Maternal mortality in the rural Gambia, a qualitative study on access to emergency obstetric care,” 2005)). There are few choices for women in the Gambia, with hardly any private health service providers. State-based care has a bad reputation for providing poor quality of services, so women typically avoid the facilities and attempt to give birth unattended. When a complication occurs, poor infrastructure further complicates a woman’s access to care, prohibiting the mother from receiving emergency services.
With a small population located in a dense and largely urban environment, providing quality services for Gambian mothers should not be such a challenge. The government has amped up services by training village health workers and traditional birth attendants, but there are still considerable gaps in the provision of comprehensive obstetric care for women in emergency scenarios. Maternal complications can happen unpredictably, and it is in these situations where death can come in an instant. With more fully developed infrastructural services and comprehensive care, these deaths could, and should, be avoided.