Objective: In sub-Saharan African countries there are unique cultural factors and
adverse physical conditions that contribute to women’s experiences of pregnancy and
birth. The objective of this study was to qualitatively explore women’s experiences of
pregnancy, childbirth, the postnatal period and maternal psychological distress in The
Gambia. Design and Methods: Semi-structured interviews were carried out with 55
women who had given birth within the previous year. Results: Thematic analysis
identified five themes: (1) childbirth as a rite of passage, (2) physical difficulties, (3)
value of children in relation to others (4) children as a strain, and (5) going through it
alone. The results suggest that having a child is a defining point in women’s lives
associated with happiness and delight. However, women also described situations
which could lead to unhappiness and distress in the perinatal period. A child
conceived out of wedlock or a baby girl can be sources of distress because of negative
cultural perceptions. The strain of having a child, particularly the additional financial
burden, and minimal support from men were also a concern for women. Finally,
women recognised the danger associated with delivery and expressed recurrent
worries of complications during childbirth which could result in the death of them or
the baby. Conclusions: Further research is needed to identify women vulnerable to
psychological distress so that health services and target interventions can be
developed accordingly.