Ugonwa Uzor-Umeaku
When 28-year-old Aisha Inuwa arrived at the Rinji Primary Health Centre in Zamfara State in late 2022, she was experiencing heavy bleeding. Two days earlier, labour had begun at home without a skilled attendant. At Rinji, the midwife administered oxytocin, although supplies were limited, and used a flashlight for lighting. Aisha was then referred to Gusau General Hospital, 40 kilometres away, by motorbike. Upon arrival, clinicians determined that further emergency interventions were needed, but she did not survive the transfer (Zamfara Health Authority 2022).
Aisha’s outcome is part of an ongoing pattern. In 2022, Zamfara recorded 156 maternal deaths in rural clinics, mostly from complications such as hemorrhage that are treatable with available medicines and timely referrals (Zamfara Health Authority 2022).
In August 2023, midwives in Edo State conducted an eight-week strike over pay and staffing concerns. According to the Edo State Health Bulletin, at least 17 maternal deaths occurred during this period in facilities without on-duty midwives (Edo State Health Bulletin 2023). For example, Grace Egharevba, a 32-year-old mother of three, experienced prolonged labour before reaching the hospital, resulting in the loss of her baby and complications that required extended care.
The Federal Ministry of Health’s 2022 Service Readiness Assessment found that 60 percent of primary health centres lacked reliable electricity, 35 percent had no essential obstetric drugs, and 45 percent did not have an adequate water supply (FMoH 2022). Staffing levels remain below global benchmarks, with Nigeria reporting 1.95 doctors and 8.79 nurses or midwives per 10,000 population, compared to the WHO’s recommended minimum of 44.5 per 10,000 (WHO 2021).
Nationally, Nigeria accounts for 82,000 of the 260,000 annual global maternal deaths, representing nearly 20 percent of the total (WHO 2023). The 2023 Nigeria Demographic and Health Survey (NDHS 2023) indicates a lifetime risk of maternal death of 1 in 18, compared to 1 in 4,900 in high-income countries (WHO 2023).
Regional disparities are significant: the North-East zone has a maternal mortality ratio (MMR) of 1,549 deaths per 100,000 live births, while the South-West reports 281 per 100,000 (NDHS 2023). Rural communities show lower rates of skilled birth attendance (37 percent) compared to urban areas (62 percent) (NDHS 2023).
Out-of-pocket expenses account for over 70 percent of healthcare funding in Nigeria, despite policies offering free maternal services in certain states (World Bank 2022). Delays in seeking care can result from transportation costs, informal fees, and supply purchases.
Household decision-making patterns also influence care-seeking. A 2021 UNFPA Nigeria report notes that male relatives often decide if and when women access health facilities, which can delay treatment for conditions that require urgent attention (UNFPA 2021).
The proportion of adolescent mothers aged 15–19 was 18 percent (NDHS 2023). Adolescents face higher clinical risks and encounter stigma, which may deter them from accessing available reproductive health services.
Basic Health Care Provision Fund (BHCPF) was introduced in 2019 to allocate at least 1 percent of national revenue to primary healthcare, the BHCPF disbursed only 40 percent of its intended funding in 2023 due to administrative delays (NPHCDA 2023).
National Health Insurance Authority (NHIA) – The 2022 NHIA Act aims to extend coverage to maternal services. However, enrollment remains below 3 percent of the population, with rural women particularly underrepresented (NHIA 2023).
Free Maternal Care Policies – Eleven states have enacted free maternal and child health programmes between 2018 and 2022. A Save the Children evaluation in 2023 found that six states maintained consistent drug and equipment supplies, while others reported stock-outs and informal charges (Save the Children 2023).
NGO and Private Sector Engagement – Organizations such as the Women’s Health Network have trained community health volunteers to recognize complications and facilitate emergency referrals, leading to a 30 percent reduction in maternal deaths in pilot areas of Ondo State (Women’s Health Network 2023). In Lagos, a public-private partnership introduced solar-powered clinics and 24-hour referral ambulances that contributed to a 25 percent increase in facility-based deliveries in participating centres.
Digital health initiatives, including an SMS-based appointment and emergency-response system in Kano State, achieved a 15 percent rise in facility births and a 30 percent reduction in missed antenatal visits over 12 months (mHealth Nigeria 2022).
Recommendations for Strengthening Maternal Care are as follows:
- Primary Care Capacity: Ensure all primary health centres have consistent power, water, essential drugs, blood supplies, and at least two skilled midwives on duty (NSHDP 2021).
- Emergency Referral Systems: Establish and maintain ambulances at district levels, with clear protocols for rapid transport from remote clinics.
- Financial Protection: Abolish out-of-pocket payments for maternal services and expand health insurance enrollment to 80 percent of pregnant women by 2028, using community outreach (NHIA 2023).
- Reproductive Health Services: Increase modern contraceptive prevalence from 17 percent to 40 percent by 2028 to reduce high-risk pregnancies and support youth-friendly services (NDHS 2023).
- Data and Accountability: Implement real-time reporting tools and publicly accessible dashboards to monitor maternal outcomes and resource availability (mHealth Nigeria 2022).
- Community Involvement: Engage men and community leaders in health education to support timely decision-making and shared responsibility (UNFPA 2021).
In conclusion, Nigeria’s maternal mortality crisis is driven by documented gaps in infrastructure, workforce, financing, and cultural practices. Recent data and programme evaluations demonstrate that targeted investments, policy reforms, and community partnerships can improve outcomes. As the government reviews health-sector priorities ahead of the next budget cycle, policymakers, health professionals, and civic stakeholders can translate these evidence-based recommendations into sustained action, ensuring that every mother receives the care she needs.
