SPECIAL REPORT: Maternal, neonatal deaths high in underserved Lagos communities

Prosper Peter, a fisherman, lost his pregnant wife in 2019 in Makoko, a floating community on the Lagos lagoon. Six years later, her memories and death still haunted him.

“My wife was in labour and we were going to the hospital in a boat when we ran into a timber log inside the water. And due to that, I lost my wife. I have not remarried because I remember her and that incident every day,” he said.

“If we had a good hospital in the community, I would have taken her there instead to deliver the baby.”

Makoko is a densely populated waterside community in Lagos. The residents live in wooden homes on the lagoon and move around in canoes. Despite its size, Makoko lacks basic amenities, including healthcare facilities.

Preventable deaths

Nigeria has some of the highest cases of maternal mortality, with 1,047 deaths per 100,000 live births, according to the World Health Organisation (WHO).

In a report titled “Improving Maternal and Newborn Health and Survival and Reducing Stillbirths: Progress Report 2023,” WHO revealed that Nigeria ranked second behind India in maternal and neonatal deaths, with 82,000 maternal deaths, 181,000 stillbirths, and 277,000 neonatal deaths.

The country’s 540,000 deaths represent 12 per cent of global maternal, stillbirth, and neonatal deaths, despite contributing just six per cent of the world’s live births.

This data reflects both Nigeria’s large population and the deep gaps in its health system.

In remote settlements and underserved communities like Makoko, the impact of these gaps is severe. Without access to emergency obstetric care or adequately equipped health facilities, women and newborns are vulnerable during childbirth.

Meanwhile, the 2023 WHO report highlighted a global crisis: a woman dies every two minutes from pregnancy-related complications, equivalent to 800 mostly preventable deaths per day.

Maternal mortality in Lagos

According to 2022 data from the Lagos State Ministry of Health, the maternal mortality ratio in Lagos was previously estimated at 555 deaths per 100,000 live births, a figure higher than the national average of 545 per 100,000 live births recorded in the 2008 Nigeria Demographic and Health Survey (NDHS).

Despite years of health interventions, recent data suggest that maternal mortality in Lagos remains alarmingly high.

A 2024 study published in the Nigerian Library of Medicine (NLM), titled “A Population-Based Estimation of Maternal Mortality in Lagos State”, revealed that one in every 51 women in the state faces the risk of dying from pregnancy-related causes.

The study employed the indirect sisterhood method, a widely used approach in settings with limited official data to assess the scale of maternal deaths through community-level information rather than hospital records. Researchers interviewed participants about the survival of their adult sisters to determine how many had died from pregnancy or childbirth-related causes.

Out of 546 deceased sisters reported during the survey, 120 (about 22 per cent) were confirmed to have died from maternal causes. This translated to a maternal mortality ratio (MMR) of 430 deaths per 100,000 live births, a figure that remains significantly above global and national targets.

The study also revealed that younger women faced higher risks. Among sisters aged 20 to 24, nearly 47 per cent of reported deaths were maternal, whereas for those aged 45 to 49, over 90 per cent of deaths were unrelated to pregnancy.

Preventable risk and sustainable solutions

The 9th of December 2024 was a dark day for another resident of Makoko, Zanu Lako, and his family.

Mr Lako, also a fisherman, lost his wife shortly after giving birth to a set of twins at a clinic in the community. When the clinic’s officials told him they could no longer handle her case, he took her to a hospital in Eastland, Eko, where she died.

“She delivered safely, but not long after, she started bleeding,” he said.

The leading causes of maternal mortality globally include severe bleeding (mostly after childbirth), infections, high blood pressure during pregnancy (pre-eclampsia and eclampsia), complications from delivery, and unsafe abortions. Most of these complications are preventable or treatable with timely medical care.

Newborn survival

While maternal mortality often dominates public health discussions, newborn survival remains an equally urgent crisis.

According to a United Nations Children’s Fund (UNICEF) report, approximately 262,000 babies die at birth in Nigeria yearly, again the second-highest number in the world.

Poor healthcare infrastructure, limited access to skilled birth attendants, and a lack of emergency obstetric and neonatal care significantly contribute to these tragic outcomes.

In rural and underserved communities, deliveries frequently take place without adequate equipment, increasing the risk of fatal complications. Unsanitary delivery conditions, absence of incubators, and lack of oxygen support for distressed newborns further worsen the situation. Without access to proper postnatal care, these children face an uphill battle from the moment they are born.

Ashley Lori, CEO of the non-profit Pad-Up, noted that in communities like Makoko, maternal and newborn challenges begin before birth. Mrs Lori explained that pregnancy and delivery are high-risk due to poor infrastructure, with many births occurring off-grid without adequate medical support.

“Deliveries often happen in the dark, using phone torches or atunpa lamps, and procedures like caesarean sections may not be possible,” she said.

Even after birth, newborns face life-threatening infections from poor sanitation and lack of preventive care. Airborne diseases, such as tuberculosis, pneumonia, and influenza, are significant risks, as are those transmitted through water and mosquitoes.

According to a 2024 report by the WHO, TB during pregnancy increases the risk of maternal death by two to three times.

The report also linked maternal TB and respiratory infections to poor birth outcomes like preterm delivery, low birth weight, and increased neonatal deaths, especially in low-resource settings.

A study, “Climate Change Impacts on Maternal Health and Pregnancy Outcomes in Africa,” also found that climate-related increases in tropical and waterborne illnesses disproportionately affect expectant mothers, contributing to higher maternal mortality rates.

Mrs Lori noted that many residents of Makoko fetch water directly from nearby dams. Because their immune systems are still developing, she said, babies can easily pick up infections like typhoid, and in severe cases, this could prove fatal.

She added that due to the waterlogged environment, children in the area are also more susceptible to diseases such as malaria and pneumonia.

To reduce these risks, Mrs Lori proposed some simple measures to protect newborns from environmental hazards. These include sleeping under mosquito nets, boiling drinking water, and limiting the baby’s exposure to contaminated water. She also emphasised the importance of regular postnatal check-ups and vaccinations for hepatitis and yellow fever.

She said the mother also needs to eat well, as her health directly affects the baby through breastfeeding.

Mrs Lori noted that the problem goes beyond infrastructure, stressing the need for community-driven solutions.

She advocated for inclusive, sustainable interventions where locals aren’t just beneficiaries but active participants, including men.

She also emphasised accountability and consistent oversight, calling for regular training, monitoring, and independent feedback to track impact. Without these, she warned, efforts from governments and donors will continue to fall short.

She added that in places like Makoko, communities must be equipped with the tools and knowledge to protect themselves, especially women and children exposed to harsh living conditions.

Health care in Makoko

Although Makoko has some health clinics, they are not equipped for obstetric emergencies.

When PREMIUM TIMES visited a clinic in the community in May, reaching it required a canoe ride through the lagoon. Built on stilts and accessible only by a shaky wooden ladder, the facility consists of a dimly lit room with a barely padded wooden bed.

Pregnant women in labour must climb from a rocking canoe up the ladder, risking their lives and their babies’ before even receiving care.

A chief in Makoko, Francis Agonyo, said many residents had died from diseases such as cholera.

Mr Agonyo lamented the lack of lifesaving equipment, particularly during childbirth complications.

“Before they take delivery, there must be some equipment there that, if an alternative comes, the instrument will help to give strength and give the woman strength to push, but we don’t have it. That’s what, at times, brings fatality.”

A primary school teacher and Makoko resident, Iroko Temitope, shared a similar sentiment.

Mr Temitope said most health interventions in the community come from NGOs and private initiatives that organise free medical outreaches. Some of these include Slum2School Africa, Jomiyon Health and Humanitarian Organisation, and Medplus Foundation.

According to him, residents often visit the Oyingbo Health Centre or the Eko General Hospital, both a few kilometres away, depending on the type of medical service they require and their financial means.

Volunteers

Steven Thousand, a community health worker, travelled to the Republic of Benin to learn basic birth attendance skills and now volunteers at a small clinic in Makoko, offering care regardless of whether patients can pay.

“Even when they can’t pay, we help them deliver safely,” another health worker at the clinic, Agonsu Ruth, said. “But we need support, medicine, and equipment to do more.”

The role of midwives

According to the WHO, over 60 per cent of maternal and newborn deaths in Nigeria could be prevented if more women had access to skilled midwives. In addition, 45 per cent of stillbirths could be avoided with adequate care before, during, and after childbirth.

In communities like Makoko, midwives are the first and sometimes only option for care.

Mocho Elen delivers babies in a clinic on wooden stilts. With no ambulance or surgical tools, her small team handles most cases with little more than experience, prayer, and determination.

For Ms Elen, her work is a form of service. “It’s a help we render to the community because it’s not the money they’re supposed to pay.

“If we have a difficult issue, we call our colleagues or refer the patient to the General Hospital.”

Akinbami Mafule, known as Yagabo, runs a small birth centre on land. Ms Mafule’s clinic serves women from Makoko and nearby communities who cannot afford or reach a hospital. Her approach blends local herbal practices with modern medication.

“We need medicine that will favour pregnant women and also favour a woman who has just given birth. Pad, medicine useful to someone breastfeeding.”

Makoko versus Lagos State

Makoko, a century-old fishing community on the Lagos lagoon, has long clashed with the Lagos State Government over demolitions and urban renewal.

The Lagos government wants to demolish Makoko as part of its urban renewal programme.

In 2012, officials issued a 72-hour eviction notice to residents of Makoko, which led to the demolition of parts of the waterfront and sparked global outrage.

In recent years, the government and private developers have proposed dredging and land reclamation projects to “beautify” the waterfront; however, residents argue that these projects threaten their homes, livelihoods, and cultural heritage.

Civil society groups also alleged inadequate consultation and the absence of compensation.

The dispute is currently pending in court.

Healthcare in Bariga

Like Makoko, Bariga, another Lagos community, struggles with gaps in maternal and newborn care.

Bariga extends onto the lagoon. Access to quality healthcare is limited, with pregnant women relying on poorly equipped clinics and overwhelmed health workers.

Francis Nnuka, a community health worker in Bariga for over 20 years, said many women face life-threatening risks during childbirth due to the long distance to hospitals, language barriers, and lack of funds for care.

“We see a lot of pregnant women here every month. Even when they can’t pay, we do our best because lives are at stake,” he said.

Fear of eviction

Ikebeji Henry, one of the community leaders, stated that the residents do not speak out about their challenges due to fear of eviction.

“Because of what happened before, when they demolished our houses, we are scared that if we speak up, they will chase us away,” he said.

During PREMIUM TIMES’ visit to the clinic at Bariga, a resident, Ayisou Alufonsie, cradled her one-month-old baby at a small clinic. She said, “The clinic lacks even basic amenities. There are no beds, no mattresses, nothing to lie on.”

Mrs Alufonsie said travelling outside Bariga for maternal care could cost up to N7,000 in transport alone. She paid between N30,000 and N40,000 for delivery at the Bariga clinic.

Funding without impact

Gabriel Nwala, a consultant paediatrician at Limi Children’s Hospital, Abuja, attributed Nigeria’s high maternal mortality to funding gaps, weak infrastructure, and poor primary healthcare systems.

Mr Nwala noted that while health budgets, such as the proposed N2 trillion for 2025, may seem large, they fall short of global standards. Nigeria has never met the 15 per cent Abuja Declaration budget allocation target, allocating just about five per cent to the health sector in 2025.

The consultant stated that even the funds allocated often fail to reach the grassroots, where they are most needed. He added that facilities are under-resourced, lack trained personnel, and are unable to provide quality care.

Mr Nwala also noted that socioeconomic barriers prevent many women from seeking care, particularly in rural areas.

“It’s not just about the funding. The people themselves often can’t afford healthcare. Women who are not empowered financially depend on their husbands, and when they can’t pay, they resort to traditional practitioners who may worsen outcomes.”

Lagos State Government plans

PREMIUM TIMES reached out to the Lagos State government over our findings in Makoko and Bariga.

In an interview, Kemi Ogunyemi, the special adviser to the governor on Health, highlighted several government initiatives aimed at strengthening maternal and newborn healthcare in communities with limited access to formal health facilities.

Ms Ogunyemi acknowledged the need for more primary healthcare centres across Lagos and said the state government was working to expand services in underserved areas.

“We know more centres are needed, and the government is working on that. The real challenge is getting skilled personnel to man these centres,” she said.

To address the shortage, she explained that the state has approved the establishment of the Lagos State University of Medical and Health Sciences, which will train more doctors, nurses, and other health professionals.

She also revealed plans to introduce more water ambulances to improve emergency access in riverine communities, such as Makoko. “We currently have just one, but we’re planning to add more so we can reach areas only accessible by water,” she said.

Regarding the regulation of traditional birth attendants (TBAs), Ms Ogunyemi stated that the government is collaborating with the Traditional Medicine Board to ensure that TBAs are properly trained and monitored.

Regarding facilities in communities like Makoko and Bariga, Ms Ogunyemi confirmed that expansion is part of the plan, but subject to available funding and personnel.

She also spoke about the state’s emergency response and referral systems for pregnant women.

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She pointed to support from the Gates Foundation through the Mamabase programme, which covers the full cost of care and transportation for indigent women.

The state also has ambulance services such as LASAMBUS, and some primary healthcare centres are linked to general hospitals with additional transport support.

“These interventions, alongside the Lagos State Health Scheme, are all part of the broader commitment under the Governor’s THEMES+ agenda, which prioritises access to affordable, quality care for all,” she said.

However, despite these promises and ongoing interventions, especially in underserved communities such as Makoko and Bariga, official records reveal a consistent mismatch between budgetary allocations and actual implementation within the primary healthcare sector.

From the state’s approved 2025 budget of N3.37 trillion, the health sector was allocated N222.2 billion, representing just 6.6 per cent of the total budget.

This falls significantly short of the 15 per cent target set by the Abuja Declaration.