By Chioma Obinna

Scientists at the Nigerian Institute of Medical Research, NIMR, have called for a national maternal and infant mortality audit system, backed by a legal framework mandating autopsies for all maternal deaths in Nigeria.

The experts who spoke during the Institute’s monthly media chat in Lagos, where the Director-General of NIMR, Prof. John Oladapo Obafunwa, raised concerns over the reliability of existing maternal mortality statistics, posited that corona on all maternal deaths would monitor data and help curb the high rate of maternal mortality in the country.

Obafunwa, who described the current statistics as incomplete and unrepresentative of Nigeria’s broader health realities, queried, “How exactly did we arrive at the maternal mortality statistics that Nigeria has today?”

“We need a nationwide coronial law that mandates autopsies in such cases. Without proper investigations, we are only scratching the surface.”

Obafunwa noted that current data often reflects only tertiary hospital cases typically the most critical while maternal deaths at primary and secondary health facilities, or with traditional birth attendants, often go undocumented.

He stressed that systemic issues such as poor access to care, quackery, and weak health infrastructure continue to fuel preventable maternal deaths across the country.

“Some of these deaths are never investigated. Unfortunately, that aspect of maternal mortality cannot be executed in isolation. It must be a national effort,” he said.

Responding to some of the questions raised by the Director General, the Director of Research at NIMR, Prof. Oliver Ezechi, stressed that most maternal deaths occur suddenly and meet the criteria for autopsy under medical law.

Recalling his training years, Ezechi who is also a Consultant Obstetrician-Gynaecologist said: “I remember cases where we thought a woman died of pre-eclampsia, only for the pathologist to find it was amniotic fluid embolism. Those reviews were not to apportion blame, but to learn—and lessons learned saved lives.”

Ezechi argued that individual physicians cannot solve Nigeria’s maternal health crisis in isolation. “Maternal mortality in Nigeria is a sign of systemic failure of health system gaps, harmful cultural practices, religious barriers, and the low societal status of women,” he said.

He said: “It’s not my portion syndrome”—a phrase women often use to reject medical advice—as an example of the cultural mindset that endangers lives. “You tell a woman her baby is lying transverse, and she says, ‘I reject it.’ Others believe laying hands on them will turn the baby. But you’re not a Hebrew woman, you’re a Nigerian woman,” he added.

He stressed the need for all women to deliver under the supervision of skilled birth attendants.

“Only two categories of people qualify—midwives and obstetrician-gynaecologists. Being a doctor or nurse doesn’t make you one unless you are trained in the art of delivery.”

On health-seeking behaviour, Ezechi noted: “It’s not that women don’t want to go to hospitals. It’s that they lack options. They can’t afford care, and when they do visit hospitals, they are sometimes treated poorly.”

“Imagine someone yelling at a woman in labour, ‘I’m not the one who got you pregnant.’ That alone can push her away from the system,” he said, urging healthcare workers to show compassion despite workforce shortages.

Ezechi further highlighted NIMR’s achievement in virtually eliminating mother-to-child HIV transmission. “Since 2004, over 7,000 pregnant women have passed through our prevention programme. In the last four years, no child born through our facility tested HIV positive,” he revealed.

He attributed the success to strict adherence to global treatment guidelines, constant review of clinical protocols, and early antiretroviral therapy for expectant mothers.

“When you stick to the science and go even beyond minimum standards, you get results. If a baby tests HIV positive today in our clinic, it’s because the mother didn’t pass through our programme,” Ezechi said.

He noted that the paediatric HIV clinic at NIMR is now “almost drying up”—a direct result of near-zero vertical transmission.

“What used to drive our paediatric HIV cases were babies born HIV positive. Now, that trend has significantly dropped.”

NIMR has also expanded its services to include cervical cancer screening, HPV vaccination, and research into integrating hypertension care within HIV treatment using task-shifting models.

“We’re piloting task-shifting in 30 Lagos PHCs to allow nurses to handle hypertension screening in HIV patients, so doctors can focus on more complex care. Early results show improved outcomes,” Ezechi said.

The experts called on the Federal Ministry of Health to reinstate policies mandating maternal death reviews and to adopt evidence-based, non-punitive audits as part of Nigeria’s national health strategy.

“This isn’t about blaming anyone. It’s about fixing a broken system. If you don’t know why women are dying, you can’t stop it. Hiding the facts helps no one,” Ezechi asserted.

With maternal mortality still among the highest in the world, and infant survival closely tied to maternal health, the experts agree that systematic reforms rooted in data, compassion, and accountability are the only path forward.