Barriers to Skilled Birth Attendance: A Survey among Mothers in Rural Gambia

Priya Miriam Lerberg, Johanne Sundby, Abdou Jammeh, Atle Fretheim


The objectives of this cross-sectional survey were to identify the most important barriers for use of skilled attendance during childbirth by women in rural Gambia. We also assessed information received during antenatal care, preparations made prior to childbirth, and experiences and perceptions that may influence the use of skilled birth attendance in rural Gambia. The most frequently stated barriers for giving birth in a health facility were not having enough time to go (75%), and lack of transport (29%). The majority of the women (83%) stated that they preferred having a health worker attending their childbirth. More than seventy percent of the participants gave birth attended by a traditional birth attendant, but only 27% had intended to give birth at home. Sixty-four percent had made advance arrangements for the childbirth. Only 22% were informed about expected time of birth during antenatal care. Our findings suggest that the participants hold the knowledge and motivation that is necessary if practices are to be changed. Interventions aiming at ensuring timely transport of women to health facilities seem key to increased use of skilled birth attendants. (Afr J Reprod Health 2014; 18[1]: 35-43).


Keywords: Childbirth, maternal health services, access, barriers, birth preparedness, complication readiness




Les objectifs de cette étude transversale étaient d'identifier les obstacles les plus importants pour se servir des accoucheuses qualifiées lors de l'accouchement. Nous avons également évalué les informations reçues lors des soins prénatals, les préparatifs effectués avant l'accouchement, et les expériences et les perceptions qui peuvent influer sur l'utilisation des accoucheuses qualifiées en Gambie rurale. Les obstacles les plus souvent mentionnés pour accoucher dans un établissement de santé  de ne pas avoir assez de temps pour y aller (75 %), et le manque de transport (29 %). La majorité des femmes (83%) ont déclaré qu'elles préféraient avoir les services du personnel médical pendant leur accouchement. Plus de soixante-dix pour cent des participantes ont accouché à l’aide d’une accoucheuse traditionnelle, mais seulement 27 % avaient l'intention d’accoucher  à la maison. Soixante-quatre pour cent avaient pris des dispositions à l'avance pour l'accouchement. Seulement 22 % ont été informées de l'heure prévue de l’accouchement au cours des soins prénatals. Nos résultats indiquent que les participantes possèdent les connaissances et la motivation qui sont nécessaires si les pratiques doivent être modifiées. Les interventions visant à assurer le transport en temps opportun des femmes aux établissements de santé semblent être la clé pour accroître l'utilisation des accoucheuses qualifiées. (Afr J Reprod Health 2014; 18[1]: 35-43).


Mots-clés: accouchement,  services de santé maternelle, accès,  barrières, préparation pour l’accouchement,  préparation pour la complication 

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