Background: Previously, the costs of maternity care services in public health facilities in The Gambia was a one-time standard fee of D5( US$0.18 ) payable on registration. Normal vaginal delivery at an institution and caesarean sections entails additional costs of D50 and D100. These fees were meant to cover drugs, medical supplies, admissions and other services including blood transfusion during pregnancy, delivery and immediate postpartum. In an effort to improve access to maternity care and subsequently reduce maternal mortality, the government of The Gambia declared in August 2007, to abolish user fees for maternal and child health care services at all public health facilities.Skilled attendants are present at 57% of deliveries and only one in five women with obstetric emergencies report to a medical facility for assistance. Thus, a great proportion of women requiring life-saving emergency obstetric care services are not getting it. Interviewing women, who have survived maternal complications, provides an opportunity to learn about their care seeking efforts and detailed aspects of costs when care is received at the tertiary level. This study intends to assess the costs borne by households to pay for emergency obstetric care in two rural hospitals of The Gambia.Objectives: To estimate the various costs women and their family pay for emergency obstetric care services and identify strategies that households use in meeting the costs face in case of needing emergency obstetric care in rural Gambia.Material and methods: The study was a hospital based retrospective quantitative study with women who were pregnant and had obstetric complications needing emergency obstetric care in AFPRC and Bansang Hospitals. Newly admitted women were identified in the registers, and as soon their health status allowed, the information sheet would be read to them and signed, on a voluntary basis. All the interviews were conducted at the time of discharge, often with the husband or other household members present who could provide supplementary information. The main outcome measure for this study is the total costs of emergency obstetric care, and we will estimate the mean cost in our study and describe the variation.Results: There were considerable variation in costs from D50 and D3000. This included costs on medicines, transport, blood transfusions, food and drinks.Conclusion: Our findings showed that despite government‟s recently launched policy of abolishing user fees for maternal care, women with serious obstetric complications are burdened with high costs due to their need for emergency obstetric care. Source of financial protection for poor women and households is essential as they suffer the greatest impact of payments and thus likely to deter them from seeking care.