Gambia

Gambia is a small country (over 7,000 square miles, slightly twice the size of Delaware) whose shape follows that of the Gambia River. It is surrounded by Senegal (except for a western border on the Atlantic Ocean) and gained its independence from the United Kingdom in 1965. It has a population of approximately 1.8 million, which is disproportionately young: the median age is 17.9 years of age; 43.6 percent of the population is 14 years of age or younger, versus only 2.8 percent age 65 years or older. The population growth rate is 2.7 percent, with a birth rate of 38.4 per 1,000, a death rate of 11.7 per 1,000, and a net migration rate of 0.3 per 1,000.

Life expectancy at birth is 53.4 years of age for men and 57.3 years of age for women. The total fertility rate (an estimate of the number of children per woman) is just over 5. The population is 90 percent Muslim and comes from several African ethnic groups, of which Mandinka is the largest (42 percent). Literacy rates are low for males (47.8 percent) and even lower for females (32.8 percent), and children are only expected to attend school for seven years.

Gambia is a poor country with limited agriculture and no mineral or natural resources. Poverty and unemployment are high: the per-capita Gross Domestic Product (GDP) is $1,300 and it is unequally distributed with a Gini Index (a measure of household inequality) of 50.2. The Gambian government expends 7.3 percent of its GDP on health, constituting less than half (44.6 percent) of the total expenditures on health: 40.6 percent comes from external sources and the rest from private expenditures.

The per-capita expenditure on health is $18. Preventive care is a priority: child immunization rates are high at over 90 percent for the most common diseases, and 92 percent of pregnant women receive at least one prenatal care visit. However, only 55 percent of births are attended by skilled personnel, and mortality rates are high: in 2000, the maternal mortality rate was 540 per 100,000 live births, the stillbirth rate was 44 per 1,000 total births, and the neonatal mortality rate 46 per 1,000 live births.

Save the Children, an international organization dedicated to improving children's health around the world, places Gambia in Tier III (least developed countries) in terms of health care services, but ranks it fairly highly among its peers (11 out of 33) on the Mother's Index, which takes into account maternal and child health indicators as well as measures of women's equality and participation in society. Gambia is on the Tier II Watch List of the U.S. Department of State for human trafficking, primarily of women and girls for sexual exploitation and domestic servitude.