Lydia Trupe
Maternal Health in Nigeria
From: Secretary of Health, Nigeria
To: Minister of Finance, Nigeria
Introduction:
Maternal mortality is one of Nigeria’s most significant concerns. Our maternal mortality
ratio is the second highest in the world, and an estimated 54,000 women die each year from
pregnancy related complications. Maternal mortality is highest among adolescents and those who
are poor, uneducated, or live in rural areas. These populations lack access to and knowledge
about modern contraceptives and have generally high fertility rates. These at-risk populations
also lack access to quality antenatal, obstetric, and postpartum care. The loss of productivity
caused by our high rates of maternal mortality and childbirth-related disability drives many
families into poverty and adversely affects our nation’s economic growth. Interventions are
needed that educate at risk populations on appropriate contraception use and birthing practices.
Access to care must also be improved, especially for those who lack both the physical and
monetary means to receive care. Additionally, the quality of our obstetric care must be improved
through the training of midwives and other skilled birth attendants.
Nature and Magnitude of the Problem:
The health of women in Nigeria is extremely poor, and the rates of maternal mortality in
our nation are among the highest in the world. Our maternal mortality ratio is 840 per 100,000
live births, which is the second highest maternal mortality ratio in the worldi. The lifetime risk of
dying during childbirth in our country is approximately 1 in 23ii. We must take steps that other
nations have taken to address these issues. While maternal mortality ratios are continuing to
decline globally, they are increasing in Nigeria. In addition to the estimated 54,000 women who
die each year from pregnancy related complications, another 1,080,000 to 1,620,000 women
suffer disabilities related to pregnancy and childbirth that leave them unable to live healthy,
productive livesiii.
Affected Populations:
High maternal mortality primarily occurs among populations who have little access to or
knowledge about family planning and obstetric care, namely those who are poor, uneducated, or
living in rural areas. Nigeria’s poorest women receive approximately 6.5 times less access to
skilled care during childbirth than their richest counterpartsiv. Many poor women are denied
access to care because they cannot pay the user fees imposed by hospitals or cannot pay for the
blood that is required for transfusions in the case of hemorrhage. Access to necessary care is
especially limited in rural areas, particularly in northern Nigeria. Women in rural areas have a
maternal mortality ratio that is 2.4 times higher than that of women in urban areasiii and are 2.7
times less likely to use modern contraceptives. Thus, nearly 70 percent of our births take place in
areas where access to care is limitediii. Uneducated women, as well, are far less likely than their
educated counterparts to receive antenatal care.
Risk Factors:
The primary risk factors for poor maternal health include poverty, rural living, lack of
access to family planning and contraception, high fertility rate, lack of access to obstetric care,
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and poor quality of care. The total fertility rate in Nigeria is high at 5.7 children per family, and it
does not appear to be decliningvi. Many women do not have access to or cannot afford modern
contraception. Contraceptive prevalence in our nation is a stunningly low 15 percenti. Major
barriers to contraceptive use include both affordability and awareness. In rural areas, only 43.8
percent of women consider condoms to be affordable.iii. Contraceptive awareness is also a key
problem, as 1/3 of women incorrectly believe that family planning can lead to infertilityiii. The
adolescent fertility rate is particularly high, at 124 per 1000 women. Reducing high fertility rates
in our country is crucial, because each pregnancy a woman has multiplies her chance of dying
from pregnancy or childbirth related complications.
The major causes of maternal mortality, including hemorrhage, unsafe abortion, and
obstructed labor—can all be treated effectively in well-staffed, fully equipped health centersv.
However, women in Nigeria experience three major delays in accessing necessary obstetric care:
delays in the decision to seek care, delays in reaching appropriate care, and delays in receiving
treatment. The first two delays are related to access to care. Many women choose not to seek
obstetric, prenatal, or postpartum care because they are unaware of its importance or they are
unable to afford it. Even women who desire to seek care are often physically unable to reach
health centers due to a lack of transportation. In rural areas, only 27 percent of births are assisted
by a midwife or other skilled birthing attendantiii. The final delay relates to the poor quality of
care in health centers, which includes a lack of skilled birthing attendants and a deficit of
necessary equipment.
Social and Economic Consequences:
The extremely high rates of maternal mortality and pregnancy related disabilities in our
country have lasting social and economic consequences on both individual families and our
nation as a whole. Children who are left without their mothers are more likely to suffer from
illness or malnutrition and are at an increased risk for early deathv. Even women who survive
severe complications from pregnancy and childbirth often face long recovery times, and their ill
health and loss of productivity may have social and economic consequences within their families
and society. Long term health problems such as obstetric fistula, anemia, and uterine prolapse
can limit a woman’s mobility and her ability to contribute to the household. Often times these
problems drive families into poverty, put children at risk of malnutrition and illness, and cause
marital problems.
Priority Action Steps:
To combat maternal mortality in our nation, we must immediately implement programs
that target the lack of access to contraception and obstetric care, concentrating particularly on
rural areas in the North with high populations of poor or uneducated women. In order to decrease
our high fertility rate, we must implement contraception education programs that target high-risk
areas and make modern contraceptives more affordable. Countries such as Malaysia and Tunisia
have seen their maternal mortality rates significantly decline as women have gained access to
family planningvii.
The three delays in receiving obstetric care must also be addressed. Delays in the
decision to receive care must primarily be addressed through birthing practice education
programs. Eliminating “user fees” from health centers would also encourage women to seek
medical care rather than attempt in-home delivery or unsafe abortions. In order to address delays
in receiving care, some organizations in Nigeria have begun partnering with local communities
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to improve their emergency transport systems to hospitalsvi. These programs should be expanded
and should target high-risk communities in the North. Finally, delays in receiving treatment must
be addressed. Many countries in the region have had tremendous success in improving obstetric
capabilities through the training of midwives in their midwifery schoolsvii. Our nation should
implement these training programs, so that our health centers may be better equipped to handle
life-threatening complications that arise during childbirth and pregnancy. It is necessary to
improve both access to and quality of care simultaneously, so that women both receive the help
they need and benefit from the services provided by our health centers.
i
UNICEF. At a Glance: Nigeria. http://www.unicef.org/infobycountry/nigeria_statistics.html. Accessed on April 8,
2011.
ii
World Health Organization. Broken Promises: Human Righs, Accountability, and Maternal Death in Nigeria.
http://www.who.int/pmnch/topics/maternal/crr_broken_promises.pdf. Accessed on April 9, 2011.
iii
USAID. Maternal and Child Health: Nigeria.
http://www.usaid.gov/our_work/global_health/mch/mh/countries/nigeria.html. Accessed on April 11, 2011.
iv
World Health Organization. Nigeria Country Profile.
http://www.who.int/making_pregnancy_safer/countries/nig.pdf. Accessed on April 8, 2011.
v
UNFPA. Maternal Morbidity. http://www.unfpa.org/public/home/mothers/pid/4388. Accessed on April 11, 2011.
vi
Pathfinder International. Nigeria:Projects.
http://www.pathfind.org/site/PageServer?pagename=Programs_Nigeria_Projects_BehaviorImprovement. Accessed
on April 11, 2011.
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