The Gambia is one of the smallest countries in Africa, and yet it has one of the highest maternal mortality ratios in the continent. According to the World Health Organization, the maternal mortality ratio in 2005 was 690 deaths per 100,000 live births. Unofficial estimates have quoted a much higher figure.

The majority of maternal deaths in the Gambia affect the rural population. Poverty is one of the main contributory factors, but the currently unacceptable high rate of maternal deaths can still be lowered despite this hurdle.

In the writer’s opinion, the most important requirement for the construction of a high quality trans-Gambia highway is efficient healthcare delivery. The referral system cannot work without good roads.

There are obvious delays in seeking health care when a woman in labour develops complications, but the women in question do so out of poverty and lack of knowledge of the severity of the situation. According to The department of state for Health, over 90% of pregnant women attend antenatal clinics at least once, the number of pregnant women who have had multiple antenatal visits is unknown to the writer, but a single antenatal visit is far from enough in terms of health education and counseling on warning signs of a complicated pregnancy/labour. Thus health workers receiving cases of complicated labour must act twice as fast considering the fact that there have already been delays in the taking and implementing the decision to seek medical care. Health workers in developing countries are notorious for not being nice to patients. The Gambia is no exception. The patients (including the dying pregnant woman) will naturally delay seeking medical care until they are 100% certain that they have to.In terms of maternal mortality, every second of delay has an effect on the outcome. Friendlier staff at health facilities would have a positive impact on reducing maternal mortality in the Gambia. Blood is another major factor contributing to the high maternal mortality rate in the Gambia. Perhaps, as a matter of policy, the relatives of pregnant women should be persuaded to donate blood long before they are due for delivery. Once donated, they could be given blood donation slips which can be traded for blood at any facility in the country. Finally, the high incidence of maternal mortality in the Gambia cannot be curtailed without accountability. Health workers should be held accountable for their practices. All incidence of negligence leading to maternal deaths must be looked into and negligent doctors, nurses etc must be cautioned. In recent years numerous interventions have been initiated by health authorities in collaboration with national and international partners to reverse the trend in maternal mortality. The most commendable program is the Emergency Maternal and Child Health (EMCH) Project which includes airlifting of complicated cases to referral centers. The outcome of this project has been very favorable. Often referred to as the “Smiling Coast”, the Gambia is less than a paradise for the scores of pregnant women who lose their lives each year during child birth. There seems to be light at the end of the tunnel with the latest interventions, and one can only hope that things will improve in the coming years.