Music, Health, and Power

The experience of maternal mental distress in The Gambia: A qualitative study identifying idioms of distress, perceptions of contributing factors and the supporting role of existing cultural practices

“…Approximately 50% of women in The Gambia fall below the poverty line [ 17 , 36 ]. However, the poverty of the country’s health system and the lack of accessibility to health resources affect all women in The Gambia.…”

“…Like many countries around the world, there is rapid social and cultural change happening in The Gambia, which has affected women’s experiences and the challenges faced during the perinatal period. For example, women now increasingly partake in supplementary income-generating activities such as vegetable gardening or selling goods at the market [ 17 , 18 ]. While for some women these changes have resulted in increased economic independence and wellbeing, they have also generated new challenges and tensions within the family as the gendered division of labour is renegotiated [ 19 ].…”

“…Strong social support networks have been found to mediate maternal mental health outcomes [ 20 ], acting as another potential protective factor. Group music making has been identified as an untapped public health resource, with studies showing that engaging the community in group music making has beneficial effects for the individual and the wider society [ 17 , 21 , 22 ] through its ability to create social bonds, increase mood and reduce anxiety and depression symptoms in the general population [ 23 ] and for those in the perinatal period [ 24 ].…”

“…The Gambia is a medically pluralistic society. People use a variety of health care options, including biomedicine (by attending their local clinics), indigenous herbal medicines, and spiritual treatments [ 17 ]. The World Bank estimates a $31 per capita health expenditure per annum, one of the lowest in the world [ 25 ] and many women experience a lack of access to healthcare, highlighting a need for solutions that are culturally embedded, low-cost, and sustainable.…”

“…The World Bank estimates a $31 per capita health expenditure per annum, one of the lowest in the world [ 25 ] and many women experience a lack of access to healthcare, highlighting a need for solutions that are culturally embedded, low-cost, and sustainable. Traditional cultural practices in The Gambia are highly diverse, including a range of musical practices that are specifically oriented toward communication, social support, and healing [ 26 , 27 ] These cultural practices are led by specialists such as griots, defined as hereditary musical experts and knowledge holders who play important cultural roles as communicators, emotional transformers and conflict mediators [ 17 ], and Kanyeleng fertility societies that are usually comprised of women who are dealing with or have dealt with infertility or child mortality and who perform music as a central part of their activities [ 17 , 28 ]. As part the World Bank-funded ‘Women in Development Project’, the Ministry of Health and Social Welfare commissioned groups of traditional communicators (TCs), built on pre-existing Kanyeleng groups, to help disseminate health related information [ 29 ].…”