Determinants of maternal health care

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The issue of maternal health has become a major concern in various health care systems around the globe. Nations are working tirelessly to reduce maternal mortality rate, with the main focus being to improve the quality and safety of the maternal health offered during pregnancy, childbirth and postpartum periods. The ability of a country to improve maternal health is determined by a number of factors, with social and economic status marking the greatest difference. In reference to Gambia and Ethiopia, this paper compares and contrasts some of the determinants that affect maternal health care delivery in these two low-income nations. The determinants in Ethiopia are as presented in the book “Cutting for Stone” by Verghese. The main reason why the two countries are chosen for the discussion is that they are both at the same economic level of development and seem to suffer from similar issues with regards to social, technological, and economic developments.

The high rate maternal mortality rates and other health issues associated with pregnancy, childbirth and postnatal periods in Ethiopia and Gambia are influenced by a number of factors, which normally affect the effort of rendering quality and safe health care services. Lack of sufficient healthcare services and poor social-cultural support affect maternal healthcare delivery in both sides.


Gambia, like in many other countries in the Sub-Saharan Africa, has several issues related to maternal health care services delivery. The country has a population estimated to be around 2 million, which makes it be among the most densely populated nations in West Africa. Over the years, the country has reported high rates of maternal-related deaths, with the latest estimate being 400 deaths out of 100,000 live births (Lowe, Chen & Huang, 2016). Among the major determinants or factors that affect the overall maternal health care delivery is lack of sufficient health care facilities and skilled birth attendants. As per various reports, despite the recent efforts to improve the country’s health care system, in Gambia, only 57% of births are attended by skilled medical practitioners (Lowe, Chen & Huang, 2016). The majority of women deliver at home or under the supervision of the traditional birth attendants. To make matters worse, very few mothers with obstetric issues are reported to professional health centers. As for the additional reports, the country has a high-risk rate of mothers dying from maternal related complications while most of the deaths occur in young women under the age of 35.

In line with the Ethiopian case, as described in the novel, “Cutting for Stone,” the same poor health care services for the pregnant women is plainly illustrated, especially in the case of Sister Mary Joseph. Similar to the case in Gambia, the novel portrays the case in Ethiopia to be almost the same. The condition of the pregnant Sister is seen to deteriorate following poor and insufficient postnatal health care. As Dr. Stone finds Mary at her quarters in bad condition, he is astonished upon realizing that she is pregnant. Being a co-worker at Missing hospital, this is a strange expression because it is obvious that Dr. Stone should have been aware of the sister’s condition (Verghese, 2010, p.34). The complication of Sister Mary was left to deteriorate due to lack of sufficient health care. Additionally, upon the realization that Sister Mary’s condition had worsened, Dr. Stone and the rest of the health care providers could not save Sister Mary because they were not given the right directive from the matron (Verghese, 2010, p.37).

The other clearly illustrated determinant of health that might affect maternal health care delivery is lack of social support from the family members and other members of the society. In Gambia, for instance, studies have noted that one of the major factors that contribute to the deteriorating of the maternal health care delivery is poor inter-house relationships and lack of proper social support. Women are being discriminated and treated unfairly in comparison to men within the region. Women in Gambia have less bargaining power within the society thus they are being left with heavy workloads and less support from other family members (Lowe, Chen & Huang, 2016). Such heavy workloads contribute significantly to the increasing cases of maternal mortality rates. Most women deliver while working in farms or undertaking heavy duties in the houses. Sometimes they do not even realize the delivery dates which, as a result, reduces the number of birth conducted in hospitals or by professional birth attendants.

Similarly, there are cases in Gambia where pregnant women receive less social and family support. Verghese illustrates a case where Sister Mary Joseph receives less support from those close to her simply because she is a nun and should not get pregnant. The author illustrates how the matron is disappointed when she realizes that the Sister is pregnant. Instead of considering her safety as a patient, she carelessly directs Dr. Stone to conduct a normal delivery while she is quite aware that Sister Mary requires a Cesarean Section: “For God’s sake, she needs a Cesarean section” (37). Such lack of support might have been the main reason why Mary chooses not to disclose her condition to her fellow medical practitioners, and as such, that results to her condition deteriorating. Similar to the case in Gambia, Sister Mary is seen to have been undertaking her duties as a nurse even though she is supposed to be resting and preparing for a safe delivery. Such factor needs to be addressed to prevent maternal mortality not only in Gambia and Ethiopia but also in other developing countries around the world.

Unlike in Gambia where there is limited access to health care and its proper utilization, the novel describes the presence of healthcare facilities and professional birth attendants in Ethiopia, but it acknowledges the negligence of those practitioners to deliver proper maternal services while required (Lowe, Chen & Huang, 2016). In Gambia, the issue of women lacking sufficient time to access health care and lack of enough health care centers is prominent. However, Verghese’s novel revolves around a health care center while the main characters are practitioners (Verghese, 2010).


From the discussion, it is clear that among major factors that determine maternal health care delivery, lack of sufficient health care services and lack social and family support to pregnant women are prevalent. The studies conducted in Gambia and the argument brought forward in the novel “Cutting for Stone’’ shows a similar picture that pregnant women and mothers face comparable issues related to lack of proper services and support from family members and members of the communities. However, one major difference is that in Gambia, women lack access to health care facilities while in Ethiopia, as per the novel, the healthcare facilities are available. From the discussion, it is thus clear that lack of sufficient healthcare services and poor social-cultural support affects maternal healthcare delivery in both sides.

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  1. Lowe, M., Chen, D. R., & Huang, S. L. (2016). Social and Cultural Factors Affecting Maternal Health in Rural Gambia: An Exploratory Qualitative Study. PloS one, 11(9), e0163653.
  2. Verghese, A. (2010). Cutting for stone: a novel. Knopf.
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