Analytical summary - Maternal and newborn health
The national maternal mortality ratio in the Gambia declined from 1050 deaths per 100 000 live births to 730 deaths per 100 000 live births between 1990 and 2001, a reduction of about 30.5% in 11 years. Levels in rural areas are twofold greater than in urban settlements. Given that it took 11 years to attain a 31% reduction, it is very unlikely that the country will attain the Millennium Development Goal 5 target of below 262 deaths per 100 000 live births in 7 years. Furthermore, met need for obstetric services such as caesarean section is very low and estimated at 2.1% nationally and 0.6% in rural areas.
While neonatal and perinatal mortality rates are estimated at 31.2 and 54.9 deaths per 1000 live births, respectively, in 2001, the under-five mortality rate has in 2003 declined to 99 deaths per 1000 live births. Currently, there are 35 prevention of mother-to-child transmission sites across the country, providing HIV counselling and testing services at antenatal clinics. There is an urgent need to expand services for improved national coverage. All pregnant women who are infected with HIV are either on antiretroviral prophylaxis or treatment, according to their disease stage.
Malaria is recognized as an important health problem, accounting for 40% of all outpatient consultations in 1999. To this end, a policy of free malaria prevention and control for pregnant women is being implemented nationally and pregnant women are given free intermittent preventive therapy in pregnancy, insecticide-treated bednets and malaria treatment.
Though fertility rates have reduced considerably from 5.4 in 1993 to 3.9 in 2003, overall fertility rate is still high. This is complicated by very high adolescence fertility, which is estimated at 103 per 1000 women. Fertility rates are higher in rural areas than in urban settlements (3.9 in the capital area but 6.2 in Central River Region). This could be explained by early marriage and fewer years spent in school in rural areas.
Nationally, the contraceptive prevalence rate has increased modestly from 12% in 1990 to 17.5% in 2001. Modern contraceptive methods account for the majority, estimated at 13.5%. The increases in the use of modern methods of contraception could be attributed to improved availability of, and access to, pills and injectables over the years.
National statistics on the magnitude of low-birth-weight babies are not readily available. However, service delivery statistics suggest the rate is above 10% nationally and up to 15% in rural areas. Malaria during pregnancy and malnutrition play no small part in this.
Malnutrition among children and pregnant women is recognized as an important public health challenge. For example, it is indicated that 73% of pregnant women manifest signs of moderate anaemia, while 5% have high-risk anaemia.
Antenatal care services are provided through a network of clinics held at base and outreach stations across the country. Thus, the national coverage is approaching universal level with over 98% of pregnant women reported to have at least four visits.
It is estimated that about 57% of births are attended by skilled personnel. This is because most births in urban areas occur in health facilities, as there are very few or no traditional birth attendants. With the policy of free maternity care services being implemented across the country, there is an element of equity in the delivery of maternal health services.
- ↑ National survey on maternal, perinatal, neonatal and infant mortality and contraceptive prevalence, 2001