Birthing in the Gambia: Educate, Empower and Enable

The BIG Project was established in 2011 in collaboration between Soroptimist International Great Britain and Ireland (SIGBI) and Maternal Childhealth Advocacy International (MCAI) to provide higher grade maternal care to combat the high maternal mortality rates in the Gambia through its motto: Educate, Empower and Enable. SIGBI's work in the Gambia is part of its Strengthening Emergency Care program (SEC), which is aimed at raising funds specially allocated for the effective provision of emergency care of pregnant women, newborn infants and children in countries with extreme poverty.

The Gambia is one of the worst places in the world to be a mother, with maternal mortality rates standing at 433 deaths per 100,000 live births last year. Considering this is an estimated fifty-nine percent reduction in recorded maternal deaths since 2000, clearly headway has been made in the prevention of premature maternal death over the last decade. Mitigating the causes of high maternal morality rates are complicated and embedded within wider issues of an underdeveloped macro-economic sector struggling in a country dealing with sixty percent poverty rates. This has been reflected in Save the Children's 2013 report 'State of the World's Mothers,' with the Gambia placed at 170 out of 176 countries on the Mother's Index, falling behind countries like Nigeria and Chad. The limited investment in maternal healthcare means there is a severe lack of trained midwives: The Gambia has approximately five midwives for every 1,000 births, which has remained unchanged since 2000.

These shocking statistics are reflected in the rural-urban disparity. Rural areas are affected by seventy four percent poverty headcount compared to urban areas (thirsty-seven percent). The Gambia has stagnated at the bottom of the Human Development Index, ranked at 168 out of 187 countries in 2011. It is clear that pervasive poverty and maternal deaths are causally linked. This is complicated by the fact the region has a high rate of adolescent pregnancies estimated at a fertility rate of 118 per 1,000 live births (MICS 2010.) At this stage in a women life, reproductive organs have not sufficiently matured which increases the risk of complications related to pregnancies and undoubtedly contribute to maternal morality, morbidity and child malnutrition. Furthermore, young women are even less likely to access health services given that very few facilities offer tailored youth-appropriate maternal care.

Yet, high maternal mortality is preventable when the resources, facilities and knowledge are simultaneously available and utilized by frontline health workers. With this in mind, SIGBI has so far raised £105,275.92 for The BIG project. These funds have helped deliver facilities and resources across the region, transforming the lives of women in the Gambia. The BIG Project's achievements include the installation of an Ultrasound Scanner in the Brikama Hospital, which serves a population of 250,000 with an estimated 600 women giving birth at the hospital each month. Since the renovation and extension of a 10-bedded labor ward, more than three times as many women have delivered at the hospital, demonstrating the necessity for improved maternal care. Further, the BIG Project has helped refurbish the maternity ward at the Essau Hospital, which serves nearly 1,400 expectant mothers. Each of these hospital units are supplied with emergency drugs to ensure staff here are sufficiently equipped to carry out their functions. Funds also go to training midwives, skilled birth attendants and doctors for the effective and timely intervention in pregnancy related emergency situations. These improvements are making more purposeful steps towards long-term sustainable improvement to maternal health in the Gambia.

Additionally, MCAI has published an in-depth medical book, which covers all aspects of hospital care for expectant women and girls, newborn and children, including dealing with complications around pregnancy and delivery. The book provides health workers with the latest evidence and guidelines available, including Cochrane reviews and WHO guidelines. In situations of chronic poverty and insufficient material and human resources, having access to peer reviewed and evidence based medical guidelines is extremely challenging. MCAI's book allows frontline health workers in the Gambia access to the most vital information to assist in accurately and effectively providing maternal care.

The BIG Project is now half way through its completion date. SIGBI is committed to reaching the target of £300,000 over the next year and half. While the newly renovated maternity wards have provided a safe and sanitary place for women to deliver, the consequence of low public expenditure on health has meant that health workers are left ill equipped to cope with the numbers of expectant mothers and their needs. SIGBI is continuing to raise the funds to ensure these maternal wards have the essential medical supplies, drugs and equipment to deliver higher quality health care. By providing a workable environment that is conducive for the successful intervention by those at the frontline of maternal intervention care, it is also simultaneously helping to retain this critical healthcare workforce. This is essential to promote capacity building around human resources for stable and consistent service delivery and ensure quantitative transformation in the health of Gambian women.

This is vitally important in remote areas of the region, which lacks even the most basic tools for health care delivery. Due to the limited facilities and lack of trust in health workers, many women in rural areas deliver in home births. The lack of appropriate transport and skilled birth attendants in these localities hinders the faster facilitation of referrals in emergency cases and is one of the major causes of maternal deaths in the Gambia. SIGBI is working to combat these health gaps by training midwives to ensure that expectant women have the necessary ante-natal monitoring and advice to women, as well as implementing better hygiene and sanitation practices during delivery. Additionally, family planning is sensitized to the cultural and religious sensibilities, which ensures greater reception and take up of maternal health care services. Further, community-based skilled birth attendants are providing additional services such as nutrition lessons, sanitation and hygiene information, immunization campaigns and disease prevention, especially against malaria.

Collectively, the partnership between SIGBI and MCAI has helped take progressive steps towards meeting Millennium Development Goals 4 and 5 in line with the Gambia's priorities in health care generally, and maternal care delivery specifically. This partnership has been vital in framing maternal health care intervention around community-based health needs and local complexities. By agreeing on a memorandum of understanding (MOU's), closer partnerships with governments, health ministries and hospitals, health care intervention will make a long-term difference to the lives of women and girls during pre and post-natal periods. This is in line with the Maternal and Child Nutrition and Health Results Project for the Gambia, which is a major development objective by the Gambian government to increase the community based maternal and child health services.

The partnership between SIGBI and MCAI has saved and transformed the lives of women in the Gambia. Significant progress has continued in 2014, encouraging greater confidence, facilitation and utilization of maternal health care services. With greater focus on training local doctors and midwives, long-term sustainable solutions have ensured more encouraging investment in maternal health needs. Through the funds raised by SIGBI, women have now been given a fighting chance to survive and thrive as stakeholders in the future of their country.

If you would like to donate to this appeal, go here for details of how to donate.