Nigeria’s maternal health emergency

This article is dedicated to my dear aunt, Ego, who passed away after childbirth in Port Harcourt, Nigeria. Her memory lives on in our hearts. 

Nigeria stands as a nation in mourning, navigating one of the highest maternal mortality rates in the world. Despite accounting for only 2.4% of the global population, the country contributes to a staggering 10% of maternal deaths. 

A Nigerian woman has a one in 22 lifetime risk of dying during pregnancy, childbirth or postpartum. In the Global North, the risk is one in 4,900. This disparity raises a critical question: Why do Nigerian mothers face such perilous odds?

The answer lies in a failing healthcare system. One exhausted by a declining economy, a strained government, and a lack of political will. Mothers in the country are carrying the burden of these issues, often paying for its failures with their lives.

Money talks 

While Nigeria’s healthcare system is diverse - consisting of public, private, modern, and traditional providers - its variety has not translated into accessibility. 

The World Health Organisation advises that an effective healthcare system should have one doctor per 600 individuals. In Nigeria, just one doctor serves more than 9000 patients.

This shortage is not an accident. Rather, a consequence of severe underfunding. Even with the largest economy in Africa, Nigeria allocates just 4% of its federal spending to healthcare - far short of the World Health Organisation’s benchmark of 15%. It should come as no surprise why public hospitals struggle to provide essential care. 

Because of this, there is an increased reliance on private healthcare providers, where treatment comes at a hefty cost. This shift has deepened existing inequalities. For many Nigerian mothers, access and quality to care is no longer a right, but a privilege determined by financial means. 

Poverty is more than just an economic struggle. In rural areas, it is a direct threat to survival during pregnancy and childbirth. With over 60% of women living in extreme poverty, prenatal care, skilled birth attendants, and emergency medical services are not an option. For them, preventable complications become fatal - turning financial hardship into a death sentence.

With most hospitals too expensive or too far away, many turn to traditional birth attendants (TBAs), who have long been trusted within rural communities. These attendants provide care that align with cultural beliefs. Their practices offer a familiar alternative in a system where formal medical care often feels out of reach.

Keeping with tradition 

TBAs are an integral part of rural communities in Nigeria. Their practices are designed to interfere as little as possible with birth. For example, encouraging women to squat to allow gravity to support delivery, incorporating herbal medicine, and relying on knowledge passed down through generations. 

Despite being highly respected, TBAs have limitations - particularly when pregnancy complications arise. Conditions such as postpartum hemorrhage, obstructed labour, and eclampsia require medical intervention beyond their capabilities. This is reflected in mortality rates which are the highest in rural areas. 

Though skilled birth attendants are available through public healthcare facilities, many women continue to seek TBAs. This is not only due to familiarity and trust but also because access to hospitals is limited. Barriers to access are not just financial. Poor roads, lack of transportation, and mistreatment at understaffed, overburdened hospitals make seeking professional care a gamble. Sometimes, the journey to a hospital is just as dangerous as giving birth without one.

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The Port Harcourt traffic was stagnant, turning a desperate car ride into a slow crawl. My aunt had just given birth, but complications arose, and the local hospital couldn’t handle it. She needed urgent care at a bigger facility across the city.

Her husband held her hand, whispering that they were almost there, but the roads told a different story—blocked and unmoving. Minutes stretched into an hour. By the time they arrived, the doctors shook their heads.

She had survived childbirth but not the journey meant to save her. Now, her baby would never know the mother who fought so hard to bring them into the world.

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To better support remote communities, some researchers are calling for further training and integration of TBAs to improve their handling of critical situations. A 2024 study led by Jaleah Rutledge reported, “Collaborations between TBAs and facility-based providers could maximize the use of extant resources in low-and-middle income countries and reduce adverse maternal health outcomes.”

However, research and action must go hand in hand. Kurt Lewin famously said, “No research without action, no action without research.” 

There have been calls for the government to step up. The World Health Organisation has set a ‘Sustainable Development Goal’ of 70 deaths per 100,000 births by 2030. A date that is just around the corner. 

Reaching this target will require more than just policies on paper. It demands urgent and sustained action. Training TBAs is a step in the right direction, but without significant investment in healthcare infrastructure maternal deaths will remain a tragedy Nigerians know all too well. 

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Header image of my mother with one of her eldest children in Lagos, Nigeria.

By Nnenna Ohaka

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