ANALYSIS: What Nigeria must do to turn the tide on maternal, newborn mortality

Motherhood should signify new beginnings, not a life-threatening experience. Yet, for millions of women around the world, particularly in low- and middle-income countries, pregnancy and childbirth continue to be fraught with danger.

Inadequate access to quality healthcare, a shortage of skilled birth attendants, poor infrastructure, and systemic failures have turned what should be a time of hope into a life-threatening experience.

Nigeria has one of the highest burdens of maternal and newborn mortality. Every day, women and infants die from preventable causes—deaths that reflect deep-rooted inequities in the healthcare system.
PREMIUM TIMES takes a closer look at the state of maternal and newborn health in Nigeria.

What data says

Maternal mortality remains a pressing global health challenge, with devastating effects on families and communities.

The leading causes of maternal and neonatal deaths can be attributed to severe bleeding (postpartum haemorrhage), infections, and high blood pressure disorders (eclampsia and pre-eclampsia).

A 2023 report by the World Health Organisation (WHO) highlighted the severity of the crisis, revealing that a woman dies from pregnancy-related complications every two minutes. This translates to nearly 800 deaths per day, the majority of which are preventable with adequate healthcare interventions.

The situation is particularly dire in Africa, which accounted for 70 per cent of maternal deaths worldwide in 2020. Within the region, Nigeria was one of the worst-affected countries.

Data from the WHO estimates Nigeria’s maternal mortality ratio (MMR) at 1,047 deaths per 100,000 live births, making it the country with the third-highest maternal mortality rate globally.

In April 2024, the Coordinating Minister of Health and Social Welfare, Muhammad Pate, reported that approximately 57,000 Nigerian mothers died in 2023 due to pregnancy and childbirth complications.

Apart from maternal deaths, newborn survival remains a significant concern. A United Nations Children’s Fund (UNICEF) report stated that approximately 262,000 babies die at birth in Nigeria each year, the second highest in the world.

All of this can be linked to poor healthcare infrastructure, limited access to skilled birth attendants, and inadequate emergency obstetric care.

Poor health system, other contributing factors

A recent investigation by Premium Times buttresses the reality of Nigeria’s inadequate healthcare system. The report exposed the severe lack of maternal care in Ogun State, where many women are forced to seek healthcare in neighbouring Benin Republic due to the poor state of local hospitals within that state.

The report highlighted the case of Kehinde Ogundipe, a Nigerian mother who carried quadruplets. With no access to a functional hospital in her state, she delivered at home, a scenario that could have led to fatal complications. It was only after her condition worsened that her neighbours rushed her and her newborns to Benin Republic’s Hôpital De Zone De Pobe.

According to the 2023 Nigeria Maternal and Newborn Health Country Profile, the North-east zone experiences some of the country’s worst maternal and newborn health outcomes due to prolonged conflict, primarily driven by the Boko Haram insurgency.

The ongoing insecurity has led to widespread displacement, disrupted livelihoods, food shortages, and protection concerns, further straining maternal healthcare in the region.

A consultant family physician, Agbor Ebuta, linked Nigeria’s maternal and neonatal health crisis to systemic inefficiencies, with financial barriers being a major challenge.

Mr Ebuta said Nigeria consistently budgets an average of five per cent of its annual budget for health, which is grossly inadequate.

“In addition, even when budgets are drawn up, actual release for the cash office falls short significantly, and is typically delayed,” he said.

Mr Ebuta, who is also the vice president of the Medical Initiative for Africa, highlighted Nigeria’s weak health insurance, stating that it has less than 10 per cent coverage, which has left many to bear high out-of-pocket costs.

He noted that the shortage of healthcare workers is worsening the crisis, with only 55,000 doctors left in the country.

He said rural communities bear the brunt, with shortages in staff, infrastructure, and essential medicines, exacerbated by insecurity, which has driven healthcare workers to cities.

Mr Ebuta further explained that Nigeria’s weak primary healthcare system, is another concern, with less than 10,000 of 30,000 PHCs functional.

He said some of these PHCs are lacking basic equipment needed to provide effective health service delivery.
Comparing Nigeria to neighbouring countries, he mentioned Ghana’s 70 per cent health insurance coverage, which has improved maternal care, while Cameroon lags at just two per cent.

“Ghana presently has an insurance uptake of 70 per cent … which means that more members of the population have access to care. Cameroon has an insignificant health insurance uptake of two per cent, an abysmal figure when compared to Nigeria.”

He emphasised that expanding health insurance, strengthening PHC supervision, improving healthcare worker welfare, ensuring budget transparency, and conducting regular audits are crucial to improving maternal and neonatal health.

Without these reforms, he warned, Nigeria’s high mortality rates will persist.

Impact of climate change on maternal and neonatal health

Beyond medical and socio-economic barriers, environmental factors are increasingly shaping maternal and newborn health outcomes in Nigeria.

Rising temperatures, worsening air pollution, and growing food insecurity, driven by climate change, have been linked to higher risks for expectant mothers and infants, particularly in tropical regions.

A study by the WHO found that for every one degree celsius increase in temperature beyond 23.9 degree celsius, the risk of infant mortality rises by up to 22.4 per cent.

Nicholas Adeniyi, a project officer at the Centre for Journalism, Innovation, and Development (CJID) and a climate change expert, explained that rising temperatures in tropical regions accelerate the breeding of microbes, nematodes, and disease-carrying insects, increasing the prevalence of infections such as malaria and Lassa fever.

“Changes in weather patterns and rising global temperatures disrupt ecological balance, creating conditions that threaten maternal and neonatal health whose immune systems are more vulnerable,” he said.

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

Mr Adeniyi highlighted that beyond vector-borne diseases, climate-induced waterborne infections such as cholera and typhoid are also on the rise, particularly in flood-prone areas.

This aligns with a report from Nigeria Centre for Disease Control (NCDC), which indicated in its 27 January – 2 February 2025 cholera outbreak report that a surge in cases disproportionately affected rural communities with poor sanitation and inadequate healthcare facilities.

Mr Adeniyi further explained that while most people can rely on medications to treat these infections, pregnant women face higher risks, as many treatments could harm foetal development. In regions with limited healthcare access, the lack of timely medical intervention only heightens the danger.

Food insecurity, Mr Adeniyi noted, is another consequence of climate change and a growing threat to maternal and newborn health.

He explained that erratic weather patterns, prolonged droughts, and pest infestations have led to rising food prices and reduced availability of nutritious produce, worsening malnutrition among expectant mothers.

This concern is supported by a 2024 study published in the International Journal of Maternal Health, which found that food insecurity among pregnant women is a significant determinant of poor maternal and neonatal health outcomes.

The study highlighted how inadequate access to nutritious food during pregnancy increases the risk of maternal underweight, foetal growth restrictions, and long-term health complications for both mother and child.

Given the far-reaching effects of climate change on maternal health, Mr Adeniyi stressed the need for climate-inclusive health policies. He emphasised that climate change is not a sector-specific issue but an all-encompassing challenge that requires integration across various policies, including maternal health interventions.

The role of diagnostics in maternal and newborn health

Accurate and timely diagnostics are crucial in maternal and newborn healthcare, enabling early detection, effective treatment, and improved survival rates.

Oghenemaro Onoronu, business head of diagnostic instruments at ISN Products Nigeria, highlighted the importance of diagnostic advancements in improving maternal and neonatal care.

According to him, genetic testing, including non-invasive prenatal testing (NIPT), is a significant breakthrough in detecting potential health risks early.

Mr Onoronu added that automation in microbiology and haematology systems can enhance the detection of infections such as sepsis, which remains a leading cause of neonatal mortality.

While some progress has been made, especially in Lagos, where primary healthcare centres now have basic haematology machines, he stressed that access to quality diagnostics remains a challenge, particularly in rural areas.

Many facilities lack essential tools, leaving healthcare workers reliant on manual methods or portable ultrasound machines from visiting doctors.

Beyond infrastructure, he identified healthcare financing and skilled manpower as critical barriers to effective diagnostics.

He stated that many healthcare facilities struggle to procure essential diagnostic equipment due to limited funding.

Additionally, he mentioned that the shortage of trained personnel, particularly in maternal and neonatal care, limits the effectiveness of available diagnostic tools.

Making a financial comparison, he highlighted that other countries provide financial support for healthcare investments, but Nigerian banks often lack specialised loan packages for healthcare providers.

He emphasised the need for greater investment in automated diagnostic systems to improve early detection and intervention.
Mr Onoronu further pointed out policy efforts addressing these issues, stating that programmes like the Maternal Mortality Reduction Innovation Initiative (MAMI) and the recent push for free caesarean sections are steps in the right direction.

He added that sustained investment in diagnostics, healthcare funding, and workforce development will be essential in reducing Nigeria’s high maternal and neonatal mortality rates.

Bridging the gaps in maternal and neonatal healthcare

The theme for this year’s World Health Day, “Healthy beginnings, hopeful futures,” highlighted the importance of maternal and newborn health, recognising the well-being of mothers and babies.

The theme focused on ending preventable deaths and ensuring that every woman receives proper care during pregnancy and childbirth, while every newborn has the best possible start in life.

WHO said the campaign will urge governments and the health community to ramp up efforts to end preventable maternal and newborn deaths, and to prioritise women’s longer-term health and well-being.