The Nigerian Institute of Medical Research (NIMR) has raised concerns over the reliability of Nigeria’s current maternal mortality statistics, questioning how such data is obtained without adequate post-mortem investigations.
During the NIMR’s monthly media briefing on Tuesday, the institute called for a national maternal mortality audit that includes mandatory autopsies for all maternal deaths in Nigeria to generate reliable data on the causes of maternal mortality and improve government response to the crisis.
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In his remarks, NIMR’s Director-General, Oladapo Obafunwa, observed that most deaths are under-reported or misclassified, particularly because they are not properly investigated.
Mr Obafunwa, a Forensic Pathology and Consultant Pathologist professor, emphasised the need for a nationwide coronial law.
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“How exactly did we arrive at the maternal mortality statistics that Nigeria has today?” he asked. “We need a nationwide coronial law that mandates autopsies in such cases. Without proper investigations, we are only scratching the surface.”
As of 2023, Nigeria records an estimated 993 maternal deaths per 100,000 live births, one of the highest rates globally.
According to the World Bank, Nigeria accounts for about 20 per cent of global maternal deaths. The most reported cause is severe bleeding (hemorrhage) during or after childbirth.
Gaps in data
Mr Obafunwa emphasised that Nigeria’s maternal death figures are often obtained from tertiary facilities that handle the most severe cases.
He warned that this gives a misleading picture of the situation, excluding deaths that occur in secondary and primary healthcare centres or under the care of traditional birth attendants.
He recounted his involvement in drafting the Lagos State Coroners Law in 2005, which made maternal deaths reportable and subject to autopsies. However, he lamented that such laws are not replicated nationwide, leaving most maternal deaths undocumented and unexplained.
In his comments, the Director of Research at NIMR, Oliver Ezechi, and a consultant obstetrician-gynaecologist noted that most maternal deaths are sudden and qualify under medical law for autopsy.
Mr Ezechi highlighted the value of autopsy findings in identifying missed diagnoses.
“I remember cases where we all thought a woman died of pre-eclampsia, only for the pathologist to reveal it was actually an amniotic fluid embolism, a diagnosis we couldn’t have made without an autopsy. Those reviews were not to blame anyone but to learn. Lessons learned saved lives,” he said.
According to Mr Ezechi, a proper audit would bring together pathologists, obstetricians, and other healthcare professionals to collectively establish the cause of each maternal death, draw actionable insights, and prevent future occurrences.
“Globally, the three leading causes of maternal death are bleeding, hypertensive disorders of pregnancy, and infection. So, the question is, why are our figures so much worse if we’re dealing with the same causes?” he asked.
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National effort needed
They agreed that reducing maternal deaths requires a joint national effort, not just from the government but also from the private sector.
They urged the Federal Ministry of Health to bring back routine past policies requiring the investigation of every maternal death in hospitals through a non-punitive, transparent review process.
“This is not about blaming doctors or nurses. It’s about understanding what went wrong so we can fix it. Hiding the facts helps no one,” Mr Ezechi said.
