Gambia’s Health Minister, Dr. Ahmad Lamin Samateh, recently presented what he described as a “phenomenal” decline in maternal mortality to the National Assembly, asserting a more than 50% reduction in recent years and positioning the country’s figures among the lowest in Africa. However, these claims are now under intense scrutiny following a detailed critique by Dr. Amadou Barrow, a US-based Gambian epidemiologist specializing in reproductive health metrics.
The minister’s presentation, based on facility-reported data from the District Health Information System (DHIS-2), cited 130 maternal deaths in 2025 among 80,720 live births, yielding a maternal mortality ratio (MMR) of 129 per 100,000 live births. Barrow recalculated using the standard epidemiological formula—(maternal deaths ÷ live births) × 100,000—and arrived at 161.1. This represents a 25% discrepancy, far beyond typical rounding.
Barrow extended the analysis to prior years, revealing inconsistencies:
2019: 100 deaths / 64,291 births → 155.5 MMR ; 2020: 79 / 63,660 → 124.1 ;2021: 135 / 65,814 → 205.1; 2022: 122 / 75,186 → 162.3 ; 2023: 156 / 76,477 → 203.9; 2024: 125 / 72,507 → 172.4 and 2025: 130 / 80,720 → 161.1
“The ministry owes the public transparency on how 129 was derived,” Barrow stated. “In epidemiology, numbers presented to decision-makers must be reproducible. This one isn’t.”
The minister’s assertion of over 50% reduction faces similar challenges. From 2023 (156 deaths, ~204 MMR) to 2025 (130 deaths, ~161 MMR), the drop is about 17% in deaths and 21% in MMR—significant but not half. Comparisons with pre-2019 baselines are problematic, as the minister acknowledged underreporting, particularly from major facilities such as Edward Francis Small Teaching Hospital. Such incomplete baselines create artificial improvements, a known issue in sub-Saharan health systems highlighted in The Lancet (2015) and BMC Health Services Research (2019).
Claims of Gambia having one of Africa’s lowest MMRs also crumble when contextualized. These are facility-based counts, excluding home births and community deaths. Recent UN inter-agency estimates (WHO, UNICEF, UNFPA, World Bank, UN Population Division, 2025) place Gambia’s 2023 MMR at 354 per 100,000 live births—more than double the facility figure and aligned with regional trends where sub-Saharan Africa averaged around 454 in 2023. Population-based estimates for neighbors like Rwanda (~259), Kenya (~530), and Sierra Leone (~443) underscore the apples-to-oranges nature of the comparison.
Barrow emphasized critical omissions in the report: no cause-specific breakdowns (e.g., hemorrhage, often ~27% globally per The Lancet Global Health, 2014), no geographic or age/parity disaggregation, no uncertainty intervals, and no near-miss data. Home deliveries and the “three delays” model (Thaddeus & Maine, 1994) mean the most vulnerable cases often go unrecorded in facility records.
“This isn’t nitpicking,” Barrow concluded. “Flawed data risks misdirecting resources in a country where maternal health remains a life-or-death priority.” With total maternal deaths from 2019–2025 reported at 847, he called for verifiable, comprehensive statistics to support genuine progress.
The Ministry of Health has yet to respond publicly to the critique. As The Gambia pursues Sustainable Development Goal targets, experts like Barrow stress that honest, robust data is essential for saving lives.
