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ISRN Obstet Gynecol. 2011;2011:981096. doi: 10.5402/2011/981096. Epub 2011 Jun 30.

Barriers to emergency obstetric care services in perinatal deaths in rural gambia: a qualitative in-depth interview study.

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Section for International Health, Department of General Practice and Community of Medicine, Institute of Health and Society, University of Oslo, P.O. BOX 1130, Blindern, 0318 Oslo, Norway.



The Gambia has one of the world's highest perinatal mortality rates. We explored barriers of timely access to emergency obstetric care services resulting in perinatal deaths and in survivors of severe obstetric complications in rural Gambia.


We applied the "three delays" model as a framework for assessing contributing factors to perinatal deaths and obstetric complications. Qualitative in-depth interviews were conducted with 20 survivors of severe obstetric complications at home settings within three to four weeks after hospital discharge. Family members and traditional birth attendants were also interviewed. The interviews were translated into English and transcribed verbatim. We used content analysis to identify barriers of care.


Transport/cost-related delays are the major contributors of perinatal deaths in this study. A delay in recognising danger signs of pregnancy/labour or decision to seek care outside the home was the second important contributor of perinatal deaths. Decision to seek care may be timely, but impaired access precluded utilization of EmOC services. Obtaining blood for transfusion was also identified as a deterrent to appropriate care.


Delays in accessing EmOC are critical in perinatal deaths. Thus, timely availability of emergency transport services and prompt decision-making are warranted for improved perinatal outcomes in rural Gambia.

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