THE REPUBLIC OF THE GAMBIA’S COMBINED REPORT ON THE AFRICAN CHARTER ON HUMAN & PEOPLES’ RIGHTS & INITIAL REPORT ON THE PROTOCOL TO THE AFRICAN CHARTER ON THE RIGHTS OF WOMEN IN AFRICA It should be noted that there are three levels in the public health care system in The Gambia, namely, the Primary, Secondary and Tertiary Levels. The services rendered at the primary level include treatment of minor illnesses, environmental health and sanitation, antenatal care, delivery and postpartum care, home visits, community health initiatives and basic outpatient services. There are 492 health posts at the primary level. Basic health care at the secondary level is provided by minor and major health centres of which there are presently 38, the major centres serving as referrals for the minor centres. The 6 public referral hospitals at the tertiary level provide specialized services not available at the secondary level. Maternal Health and Infant Mortality Maternal and antenatal health care is freely offered in all Government health centres. Primary and secondary health care has also significantly expanded, and increased immunization has reduced mortality rates. The infant and under 5 mortality rates is at 81 and 109 per 1000 respectively as per The Gambia Multiple Indicator Cluster Survey 2010 Report. This is an impressive fall in mortality indicators compared to MICS 2005/2006 which showed 98 and 141 per 1,000 respectively for infant and under-5 mortality. Compared with other countries in the sub-Saharan region, childhood mortality is relatively low in The Gambia. Under5 mortality for the period 0-4 years before the GDHS survey, which corresponds approximately to the calendar years 2009-2013, is 54 deaths per 1,000 births. Following the usual pattern, most of the early childhood mortality occurs in the first year of life; the infant mortality is 34 deaths per 1,000 births, while mortality between the first and the fifth birthday is 20 deaths per 1,000. As expected, neonatal mortality (mortality during the first month) is higher than post neonatal mortality (22 deaths per 1,000 compared with 12 deaths per 1,000), representing 65 percent of the overall infant mortality. Mortality shows a downward trend. Infant mortality decreased from 50 deaths per 1,000 births in the 10 – 14 years before the survey (1999 – 2003) to 46 in the 5 – 9 years before the survey (2004 – 2008) and 34in the 0 – 4 years before the survey (2009 -2013). In The Gambia, a large majority of women receive antenatal care from a skilled provider, and 86 percent of women received antenatal care from a skilled health professional, that is, a doctor, nurse, or midwife during 66