Despite having the largest economy in Africa, Nigeria faces significant challenges regarding maternal and adolescent health. The country loses more women to death in childbirth than most other countries in the world. This article delves into the statistics surrounding pregnancy in Nigeria, the factors contributing to these figures, and the efforts being made to improve the situation.
Maternal Mortality Rates
In 2020, approximately 82,000 Nigerian women died due to pregnancy-related complications. This figure represents a slight improvement from the previous year but an increase compared to previous decades. Nigeria’s rate of 1,047 deaths per 100,000 births in 2020 is the third-highest maternal mortality in Africa and far from the UN goal of 70 deaths per 100,000 to be reached globally by 2030.
The causes of death included severe haemorrhage, high blood pressure (pre-eclampsia and eclampsia), unsafe abortion, and obstructed labor. Doctors and activists attribute these high rates to a lack of trust in a broken public healthcare system and insufficient political will to fix it.
“The road to maternal mortality is filled with delays,” says Togunde, obstetrician and gynaecologist, and the head resident of the Lagos Island maternity hospital. Each time Togunde loses a patient, he wonders about her family. He sees the pain of her parents or partner but thinks of the consequences that go further. “Each time with a death of a mother, a household, a community, is destroyed,” he says. “The children she had don’t have their primary carer - some drop out of school, most are sent to distant relatives; siblings are separated. Once the mother is gone, her family is scattered.
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“I understand that people are dying from lethal diseases, but pregnancy is not a disease,” says Dr Moses Olusanjo, a senior consultant at the maternity ward of Lagos State University teaching hospital, the principal referral centre for patients in Lagos with complications. He adds, “The problem of maternal mortality is a reflection of how our society works. Until the standard of life increases, this will not go away. The reduction of maternal mortality is solely within the power of our leaders. The problem is too vast for doctors alone to handle. It takes political will to say that our women will not die.”
Challenges in the Healthcare System
The World Health Organization recommendation for a functioning healthcare system is one doctor for every 600 people; in Nigeria, the ratio is one for every 4,000-5,000 patients. The federal budget for healthcare in 2024 is 5%, a record high, but far short of the 15% suggested by the UN.
Most Nigerians live in areas without well-equipped medical centers or have to pay upfront for treatment. During pregnancy, women skip prenatal check-ups, choose traditional healers and often don’t resort to seeking professional medical help until it is too late.
There are delays too in the hospital itself. Togunde deals with patients shifted from one facility to another due to lack of space. The Lagos Island hospital has rigorous protocols. It has reduced the number of maternal deaths in the past 10 years from 93 in 2013 to 38 in 2023.
“Manpower is a problem,” says Togunde. “We have space, but sometimes we don’t have people to operate. The hospital does not employ staff [they are employed by the government], it is beyond our competence, and doctors emigrate. The young ones don’t even stay. Sometimes people just leave without notice, so you cannot guarantee the number of staff you will have the next day.”
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The Story of Lawal
The patient Lawal, 31, arrived at the Lagos Island maternity hospital early in the morning. Her uterus was not contracting after a caesarean section at a private health centre the previous day. She was losing blood and had acute renal failure. The hospital lifts had been broken for months and ground-floor theatres were unavailable, so as she went into cardiac arrest she was carried on a stretcher to a second-floor operating room.
Despite all efforts of hospital staff, Lawal did not wake up from the surgery. The septic shock that she arrived with turned into multiple organ disfunction. She died in the hospital’s ICU eight days later.
Adolescent Pregnancy
Adolescence is a critical period in which significant physical, social, psychological, and reproductive health changes occur between ages 10 and 19. In Nigeria, the prevalence of adolescent pregnancy is between 7.5 and 49.5%. Adolescent pregnancy is often unplanned and considered the most unfavourable outcome of adolescent sexual activity.
In 2021 Nigeria’s Adolescent pregnancy was 106 per 1000 and showed an increasing rate. In the sub-Saharan African Region, the pooled prevalence of adolescent pregnancy is 19.3%, with East Africa having the lowest prevalence (21.5%) and Northern Africa having the highest (99.2%).
Associated factors for adolescent pregnancy in Nigeria are multifactorial, including individual, community, societal, school, family, and peer factors. Policies on adolescent sexual and reproductive health exist in Nigeria. Associated factors for adolescent Pregnancy in Nigeria are multidimensional, with educational attainment and wealth index being the highest associated factor. Intervention strategies aimed at the educational level have been identified as a critical factor in curbing adolescent pregnancy.
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Early adolescent sexual activity has been identified as a significant factor contributing to the high prevalence of adolescent pregnancy in Nigeria. Studies have shown that a higher incidence of multiple sexual partners, unprotected sex, unwanted and adolescent pregnancy, and unsafe abortions are associated with early sexual debut. Marriage is a significant factor associated with adolescent pregnancy in Nigeria, as married adolescents are more likely to get pregnant than unmarried ones.
Peer pressure has been identified as a significant factor influencing adolescent pregnancy in Nigeria, as evidenced by several studies. Adolescents are often influenced by their peers, who can serve as agents of socialization and shape their attitudes and behaviors towards sexual activity. To address this issue, there is a need to educate adolescents on healthy relationships, sexual behaviors, and the risks associated with early sexual activity.
Data collected in 2018 show that 19% of Nigerian girls aged 15 to 19 years have reported pregnancy compared to 23% in 2013, a decrease of 4% in 5 years. This is a very low return on investment that can easily be surpassed by the projected widespread increase in adolescent pregnancy as a result of continued population growth in Nigeria.
Higher odds of adolescent pregnancy in Nigeria were found among girls with household heads aged in the 15-24 and 25-34 groups compared to those with household heads aged 45 and older.
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Spatial Distribution of Adolescent Pregnancy
The spatial distribution of adolescent pregnancy in Nigeria ranges from 0 to 66.67%. A high proportion of adolescent pregnancy was located in the Northern parts of Nigeria.
The likelihood of adolescent pregnancy in Nigeria was high among those who had sexual debut between 15 to 19 years, those who were currently married, and adolescents whose ethnicity were Igbo, while adolescents who were currently working were less likely to have adolescent pregnancy.
The spatial autocorrelation of adolescent pregnancy was clustered in Nigeria across all regions.
The Role of Activists and Organizations
Abiola Akiyode-Afolabi runs the Women Advocates Research and Documentation Center (WardC), an organization aimed at combatting maternal mortality and gender-based violence. She believes much greater political commitment is required. In 2014, her organization and several others filed a petition to the African Commission on Human and Peoples’ Rights, charged with ensuring that African states comply with human rights obligations, to reaffirm Nigeria’s duty to end preventable maternal mortality.
“We hope it will help to increase budgets, establish a national plan and take the matter seriously on a national scale,” she says.
The Importance of Family and Community
In Nigeria people depend on their extended families, especially the women who hold communities together. Every time Togunde loses a patient, he wonders about her family. He sees the pain of her parents or partner but thinks of the consequences that go further.
“Each time with a death of a mother, a household, a community, is destroyed,” he says. “The children she had don’t have their primary carer - some drop out of school, most are sent to distant relatives; siblings are separated. Once the mother is gone, her family is scattered.
Key Statistics on Pregnancy in Nigeria
The following table summarizes key statistics related to pregnancy in Nigeria:
| Statistic | Value |
|---|---|
| Maternal Mortality Rate (2020) | 1,047 deaths per 100,000 births |
| Adolescent Pregnancy Rate (2018) | 19% of girls aged 15-19 |
| Healthcare Budget (2024) | 5% of federal budget |
| Doctor-Patient Ratio | 1 doctor per 4,000-5,000 patients |
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