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By Doris Obinna
Nigeria continues to confront one of the highest maternal mortality rates worldwide. Maternal mortality refers to deaths due to complications from pregnancy or childbirth. From 2000 to 2023, the global Maternal Mortality Ratio (MMR) declined by 40 per cent; from 328 deaths to 197 deaths per 100,000 live births, according to United Nation inter-agency estimates.
According to United Nations Children’s Fund (UNICEF), there has been significant progress in reducing global MMR between 2000 and 2015, the numbers have been stagnant when averaging rates of reduction between 2016 and 2023, however, progress has slowed since the start of the decade and without further attention to renewed commitment, multiple countries risk being left behind especially those facing humanitarian crises where maternal deaths are already alarmingly high.
UNICEF, World Health Organization (WHO) and other partnering agencies are working closely with country governments and other partners to accelerate progress in maternal and newborn health. While substantive, achieving the Sustainable Development Goal (SDG) of 70 maternal deaths per 100,000 live births by 2030 will require an annual rate of reduction of almost 15 per cent over the next seven years (2024-2030).
This revelation has prompted renewed calls from health professionals, civil society leaders and media practitioners for state governments to urgently strengthen funding for Family Planning (FP) and Maternal, Newborn and Child Health (MNCH) programmes to stem the tide of preventable deaths.
Experts described the country’s maternal health trajectory as tragic; particularly because nearly 90 per cent of the deaths are preventable. Unsafe abortions, haemorrhage, premature births and malnutrition remain major contributors, all of which are exacerbated by inadequate access to quality healthcare. According to them, it is quite unfortunate that maternal mortality in the country is on the high side of which most of these deaths are avoidable.
World Health Organisation (WHO) estimates Nigeria’s maternal mortality ratio was 1,047 deaths per 1000,000 live births in 2020. This positions Nigeria as having the third-highest maternal mortality rate globally and means approximately 20 per cent of global maternal deaths occur there, according to 2023 data with preventable causes including haemorrhage, sepsis and hypertensive disorders being major factors. Contributing issues include limited access to quality healthcare, overstretched and underfunded health systems, and the impact of crisis like conflict in the northeast.
At the two-day capacity-building workshop convened by Pathfinder International Nigeria under its Smart Advocacy for Strategic Action (SASA) project and organised in partnership with PPDARO and Jhpiego Kenya, presentations from across various states painted a bleak but familiar picture: chronic underfunding, delayed release of approved health funds, poor medical infrastructure, inadequate supplies, low remuneration for health workers, entrenched poverty, and cultural or religious barriers that discourage the use of health facilities. These systemic failures have contributed to a widespread distrust of the healthcare system, particularly in remote and rural communities.
Causes of maternal death
According to experts, maternal death can be caused directly by postpartum haemorrhage, pre-eclampsia and hypertensive disorders, pregnancy-related infections, and complications of unsafe abortion, as well as indirectly by pre-existing medical conditions aggravated by the pregnancy:
The complications leading to maternal death can occur without warning at any time during pregnancy and childbirth. However, some can be screened and prevented. That is why UNICEF and the partnering organizations are working to ensure that monitoring and identifying high-risk pregnancies through antenatal care are available for every pregnant girl and woman.
Most maternal deaths can also be prevented if skilled health personnel such as doctors, nurses or midwives attend births. As complications require prompt access to quality obstetric services, these skilled health personnel, who are regularly supervised and have the proper equipment and supplies, can avert maternal death by providing life-saving drugs such as antibiotics, blood transfusions, caesarean sections, and other surgical interventions.
Stark disparities and funding gaps
Case studies drew from the Federal Capital Territory (FCT), Kaduna, Kano and Lagos highlighted deep inequalities in access to family planning and maternal health services. While urban residents in the FCT benefit from relatively easy access to healthcare, rural communities across the six area councils remain largely underserved.
In Kaduna, participants lamented the persistent lack of funding for family planning initiatives. Although N70 million was allocated in the state’s 2024 budget, the funds have yet to be released, with the year nearing its end.
Kano, which records the highest maternal mortality rate in the country, has made measurable progress, raising its contraceptive prevalence rate from 0.5 per cent in 2013 to 11.1 per cent in 2023. However, unmet needs for family planning have simultaneously risen from 11.1 per cent to 26 per cent over the same period. Experts attributed this to persistent myths, cultural resistance and frequent stock-outs of contraceptives.
To address these challenges, the state introduced a Child Birth Spacing Strategic Plan in December 2024 targeting 756 health facilities and, in 2023, passed a Free Maternal and Child Health Care Law making it Nigeria’s first state to legislate such a policy. Yet, experts say far more is required to achieve lasting change.
Consistent commitment
While Lagos state with an estimated population of 17.2 million was highlighted as an example of sustained commitment to reproductive health. Current data shows that while 59.7 per cent of sampled women use some form of contraception, only 38.5 per cent rely on modern methods. The state’s total fertility rate stands at 3.807, with a maternal mortality ratio of 430 deaths per 100,000 live births.
The state provides free family planning services, free antenatal care, and free delivery, including caesarean sections across public hospitals. Supported by partners such as the Bill & Melinda Gates Foundation, Lagos has adopted the slogan “Childbirth is not a death sentence: Safe childbirth is a fundamental human right.”
So far, Lagos also ensures timely budget releases and operates Ilere-Eko, a health insurance scheme widely regarded as beneficial for women. Through its Sector-Wide Approach (SWAp), the state aligns local and federal institutions with development partners under a single strategic framework to improve coordination and evidence-based service delivery.
Despite these gains, officials acknowledged that resource constraints persist particularly as the state’s population continues to rise.
Calls for government accountability
At the workshop, Chair, Nigeria Civil Society Organisation (CSO) Focal Point for FP2030, Dr Ejike Oji and Senior Media and Communication Officer, Pathfinder International, Bayo Ewuola urged both federal and state governments to prioritise the procurement and distribution of family planning commodities.
While Oji expressed concern that out of the $4 million approved earlier this year for FP commodities, only N60 million had been released. He commended the minister of health for securing $60 million for family planning procurement through the National Primary Health Care Development Agency (NPHCDA) the largest such approval in Nigeria’s history. Additional interventions include N5.77 billion allocated through the Presidential Initiative for Value Chain and a presidential approval of $200 million for USAID-supported HIV, malaria and tuberculosis interventions.
Oji advocated purchasing commodities through USAID, noting its economies of scale that benefit over 53 countries and reduce procurement costs. He explained that by contributing $357,000, Nigeria could unlock a $2 million matching grant; funds that could further strengthen service delivery and improve quantification processes.
Emphasising strategic engagement using both traditional and new media platforms is essential for sustained awareness, he urged journalists to demand the release of the 2023 FP/MNCH data report.
Contributing factors and solutions
WHO stated that many women lack access to maternal and newborn healthcare services due to financial and geographical barriers; poverty is a foundational cause, leading to poor nutrition, lack of education on risks, and inability to afford treatment, transport, and other necessary costs; poor infrastructure, including long distances to health facilities and a lack of reliable transport, contributes to delays in reaching care; a shortage of skilled birth attendants, essential medical supplies (like blood for transfusions), and equipment also increases risks and complications, which are major causes of maternal death include hemorrhage, eclampsia, and infections:
Skilled birth attendance: Efforts focus on ensuring childbirth is assisted by a skilled birth attendant.
Antenatal and postnatal care: Increasing access to antenatal and postnatal care within two days of birth is a key intervention.
Improving emergency care: Some initiatives aim to educate community-based providers to recognize high-risk pregnancies and ensure timely referrals to tertiary facilities.
Family planning and contraception: Expanding access to family planning services can help reduce unwanted pregnancies and unsafe abortions.
