Nigeria is currently facing a daunting maternal and child health crisis. The country’s levels of maternal and child mortality are among the highest in the world, with maternal mortality representing 20% of the global burden. In 2023, Nigeria accounted for well over a quarter - 29% - of all maternal deaths worldwide. That is an estimated total of 75,000 women dying in childbirth in a year, which works out at one death every seven minutes.
According to the most recent UN estimates for the country, compiled from 2023 figures, one in 100 women die in labour or in the following days. That puts it at the top of a league table no country wants to head.
In 2017, the World Health Organization (WHO) Africa Region estimated Nigeria’s maternal mortality rate was estimated at 917 per 100,000 live births. Fast forward to 2020, it increased by nearly 14% to reach 1047 deaths. This meant that out of every 100 births in 2020, at least one woman lost her life due to complications during pregnancy or childbirth.
Infant and under-five mortality rates data by UNICEF also paints a grim picture of the situation. One Nigerian child of every 13 born dies before reaching age one, and one in every eight does not survive to their fifth birthday.
These hard hitting facts position Nigeria as a country where nearly 20% of all global maternal deaths occur and the factors contributing to this crisis are multifaceted. Many women in the country lack the resources and access to maternal and newborn healthcare (MNH) services, and on top of that, cultural beliefs and societal norms are exacerbating the risks involved during pregnancy and postpartum stages.
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The WHO says the high number of maternal deaths in some parts of the world reflects inequities in access to health services, and highlights the gap between rich and poor. WHO adds that poor women in remote areas are the least likely to receive adequate health care. This is especially true for regions with low numbers of skilled health workers, such as sub-Saharan Africa and South Asia.
Nigeria’s 40 million women of childbearing age (between 15 and 49 years of age) suffer a disproportionally high level of health issues surrounding birth. While the country represents 2.4 per cent of the world’s population, it currently contributes 10 per cent of global deaths for pregnant mothers. Latest figures show a maternal mortality rate of 576 per 100,000 live births, the fourth highest on Earth.
Each year approximately 262,000 babies die at birth, the world’s second highest national total. Infant mortality currently stands at 69 per 1,000 live births while for under-fives it rises to 128 per 1,000 live births. More than half of the under-five deaths - 64 per cent - result from malaria, pneumonia or diarrhoea.
The rate of those mothers feeding new-borns exclusively with breastfeeding for the first six months of life which remains stuck at around 17 per cent of infants, unchanged over the last decade. Only 18 per cent of children aged 6-23 months are fed the minimum acceptable diet.
Although primary education is officially free and compulsory, only 67 per cent of eligible children take up a place in primary school. Girls suffer more than boys in terms of missing out on education. In the north-east of Nigeria only 41 per cent of eligible girls receive a primary education, 47 per cent in the north-west.
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Nigerian children are vulnerable to a wide range of abuses and harmful traditional practices. A national survey in 2014 found that 6 out of 10 children reported having suffered one or more forms of violence before reaching 18 years of age, with 70 per cent of those experiencing multiple incidents of violence.
At 27 per cent, the prevalence of female genital mutilation/cutting (FGM/C) among girls and women aged 15-49 years is lower than in many countries where the practice is carried out, but Nigeria still has the third highest absolute number of women and girls (19.9 million) who have undergone FGM/C worldwide.
With millions displaced by conflict in some parts of northern Nigeria, already significant challenges in healthcare, WASH and education have all been intensified.
Roads are closed by fighting. Many doctors and other health workers, as well as aid organizations, have fled. Aid workers described local mothers dying because they could not reach care.
There is also a severe lack of doctors. The shortage of staff and facilities puts some off seeking professional help.
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The economic downturn over recent years has exacerbated these issues, rendering health services unaffordable for many. Many women forgo their prenatal check-ups, choosing traditional healers instead. Many women also now opt for home births to avoid costs, undermining the gains made in hospital births.
Challenges Persist
Despite significant strides, challenges remain. The health of women, children and youth is still underfunded. As a result, women and children, especially in areas without well-equipped health facilities and human resources are dying preventable deaths. Zainab Umar Ciroma, Facility in Charge in Tudun Wada, notes ongoing staff shortages and long wait times. “We used to have more and better motivated health workers due to improved conditions and pay, but now that’s changing,” she says.
Initiatives and Efforts to Improve Maternal Health
Despite these challenges, various initiatives are underway to improve maternal and child health in Nigeria.
Through the establishment of a Basic Health Care Provision Fund the government was able to channel more resources to primary health care across the country. Financing and technical assistance from the Global Financing Facility for Women, Children and Adolescents (GFF), helped pilot this program in three states, and mobilized government resources to expand it nationwide. The efforts helped to strengthen about 900 primary health care facilities with critical infrastructure like maternity wards, medicines and skilled health workers.
At the same time, the GFF and the World Bank supported the Nigeria State Health Investment Project to reach communities in the Northeastern region of Nigeria which has been grappling with conflict and weakened health systems, leaving many without health care. Adolescent health also became a priority given Nigeria’s large youth population. Through the Accelerating Nutrition Results project supported by the World Bank and the GFF in Kaduna State, adolescent girls are now accessing better information and counseling on family planning, leading to increased use of modern contraceptives. Highly trained health workers also visit communities and provide nutritional advice to families. Covering a total of 12 states in Nigeria, the project helped provide nutrition services to nearly 5 million pregnant women and over 7 million children under five and supported the treatment of children from amongst the 2.6 million affected by severe malnutrition nationally.
Building on lessons from past initiatives, the government has unveiled the Nigeria Health Sector Renewal Investment Initiative, a bold plan designed to crash maternal and child mortality. This initiative adopts a Sector Wide Approach (SWAp) to foster alignment among partners around national health priorities, which is crucial in a resource-constrained environment. The World Bank’s recently approved $570 million primary health care project is an example of bringing together financing from multiple partners. The new financing comprises of $500 million from the World Bank and $70 million in grants from the GFF, with contributions from the UK’s Foreign, Commonwealth & Development Office and the Children’s Investment Foundation Fund through joint financing with the GFF.
The Role of the Wellbeing Foundation Africa (WBFA)
Amidst these challenges, the Wellbeing Foundation Africa (WBFA) is creating hope through its MamaCare360 program, which not only addresses the maternal and newborn mortality crisis but also promotes dignity and autonomy of women during childbirth. The MamaCare 360 program is a WBFA initiative focused on providing comprehensive healthcare support to mothers, particularly in underserved communities, throughout every stage of their journey - from pregnancy to early motherhood. By integrating medical care, education, and community support, WFBA is ensuring that mothers receive the help they need to have safe and healthy pregnancies.
With education as one of its cornerstones, WBFA’s flagship program - the MamaCare Antenatal and Postnatal Education Programme runs weekly workshops led by qualified midwives across seven states in Nigeria - Lagos, Kwara, Abuja, Cross River, Osun, Kano and Sokoto. These workshops cover important topics on family planning, sexual, reproductive, maternal, newborn, child, and adolescent health and nutrition (SRMNCAH+N) as well as promote water, sanitation and hygiene (WASH) behaviours.
Since its inception in 2004, WBFA has been committed to achieving better maternal and child health outcomes in Nigeria and in Africa. So far, the organization’s MamaCare360 program has impacted the lives of over 420,000 pregnant women and 212,720 nursing mothers.
Postpartum Depression (PPD)
Another critical but commonly overlooked aspect of maternal healthcare is the range of mental health conditions that arise during pregnancy and up to one year postpartum. These conditions include depression, anxiety, post-traumatic stress disorder (PTSD). A study published by African Health Sciences in 2020 revealed that the prevalence of postpartum depression (PPD) in western Nigeria ranged from 14.6% to 23.0%. Two separate studies in southeastern Nigeria also found a low prevalence of 10.7% in one study and a higher prevalence of 30.0% in the other. In northern Nigeria, the reported prevalence rates were notably high, at 21.8% and 44.5%.
Just like maternal and child health crisis, Postpartum depression (PPD) is influenced by similar socio-demographic and obstetric factors such as Unplanned pregnancies, pregnancy complications and history of abortions. Additional risk factors include previous history of mental health disorders, stress and marital issues.
By recognising this aspect of maternal healthcare, WBFA’s MamaCare360 program takes a unique approach to help women in these situations through counselling, peer support groups, and community outreach initiatives in different states in Nigeria.
While Nigeria faces daunting challenges in maternal and child health, initiatives like the MamaCare360 program is making strides in reducing maternal mortality rates and enhancing the overall wellbeing of women and children across the nation.
Table: Key Maternal and Child Health Statistics in Nigeria
| Statistic | Value |
|---|---|
| Maternal Mortality Rate (2020) | 1047 per 100,000 live births |
| Infant Mortality Rate | 69 per 1,000 live births |
| Under-Five Mortality Rate | 128 per 1,000 live births |
| Maternal deaths worldwide | 29% |
Maternal Mortality In Nigeria | Causes, and Solutions #GivingBirthInNigeria
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