By Rasheed Sobowale

Several reports have shown that maternal mortality continues to expose deep structural weaknesses in healthcare systems globally. According to a release by the United States Centers for Disease Control and Prevention on the peventability of pregnancy-related deaths, over 80 per cent of maternal deaths are preventable. As for Nigeria and Africa, research revealed that there is little to no adequate data collection on maternal death that can show the level of loss experienced in the region.

In an exclusive interview with our correspondent, Amala Okafor, a maternal health researcher, noted that this crisis not merely a public health concern, but a question of governance, law, and accountability.

Okafor, a US-based legal writer and women’s rights advocate, argued that the persistence of maternal deaths, particularly in Nigeria and across Africa, reflects systemic failures that go beyond clinical outcomes. She explained thatthe issue must be reframed as a matter of enforceable rights rather than just policy aspiration.

She explained that maternal mortality in Nigeria remains one of the clearest indicators of institutional weakness, noting that the scale of preventable deaths raises serious legal and constitutional concerns.

“Maternal mortality in Nigeria and across Africa remains one of the most persistent indicators of systemic governance failure, public health underdevelopment, and legal under-enforcement,” she said, adding that the crisis is rooted in weak institutions, inadequate financing, and the absence of enforceable accountability frameworks.

Drawing from her analysis, Okafor noted that though a significant proportion of maternal deaths in Nigeria are preventable, yet continue to occur due to structural deficiencies in healthcare delivery. She explained that beyond infrastructure and funding gaps, the problem is deeply connected to how the law is interpreted and enforced.

According to her, the right to life, as provided under Nigeria’s Constitution, should not be narrowly construed. Rather, it should encompass access to essential maternal healthcare, particularly in situations where death is foreseeable and avoidable.

She noted that Nigerian courts have, in certain instances, adopted a broader interpretation of fundamental rights, creating an opening for maternal health to be treated as a justiciable issue. However, she stressed that this potential has not been fully realised, largely due to the persistent challenge of non-justiciability of socio-economic rights and weak institutional enforcement.

Okafor further explained that while frameworks such as the National Health Act 2014 were designed to improve access to healthcare, implementation gaps continue to undermine their effectiveness. She pointed to inconsistent funding, poor oversight, and fragmented governance structures as key barriers to progress.

“Maternal mortality, in this sense, is not merely a health outcome but a constitutional failure,” she said, emphasising that the state’s inability to provide timely and adequate maternal care raises fundamental questions about its legal obligations.

She also highlighted structural determinants such as financial barriers, limited access to skilled healthcare providers, and systemic delays in accessing care, noting that these factors collectively contribute to avoidable deaths.

Beyond domestic legal frameworks, Okafor pointed to regional instruments such as the African Charter on Human and Peoples’ Rights as providing a stronger legal basis for enforcing maternal health rights. According to her, the Charter’s provisions on the right to health, dignity, and life create a multi-layered framework through which states can be held accountable.

However, the analyst stressed that legal recognition alone is insufficient without institutional reforms, sustained funding, and transparent accountability mechanisms.

While her analysis situates maternal mortality in Nigeria and Africa within a context of structural underdevelopment and weak enforcement, Okafor noted that even in more advanced healthcare systems, similar failures persist, albeit in different forms.

In comparison with the United States, she explained that the maternal health crisis reflects fragmentation within an otherwise developed system, rather than a complete absence of infrastructure.

“The US continues to record one of the highest maternal mortality rates among developed countries,” she noted, citing data showing approximately 17.4 deaths per 100,000 live births as of 2024, nearly double that of comparable nations.

According to her, this paradox highlights the limits of policy interventions that are not backed by cohesive legal and institutional frameworks.

The rights advocate explained that despite major initiatives such as the Affordable Care Act and the Black Maternal Health Momnibus Act, the crisis persists due to fragmented policies, inconsistent implementation, and disparities in standards of care across states.

She noted that these systemic failures come at a significant cost, both in human lives and economic terms, with maternal health challenges in the United States estimated to cost over $30 billion annually, adding that the persistence of such outcomes points to failures in coordination of care, access to services, and continuity of coverage.

Okafor further highlighted racial disparities as a defining feature of maternal health outcomes in the United States, noting that Black and Indigenous women face mortality rates significantly higher than their white counterparts.

She explained that these disparities are not incidental but reflect systemic inequities embedded within healthcare structures, including differences in insurance coverage, access to care, and broader socio-economic conditions.

In addition, she pointed to policy fragmentation as a major challenge, particularly in relation to Medicaid coverage, where many women lose access to care shortly after childbirth.

“These coverage gaps occur at a critical period when ongoing care is essential, thereby increasing the risk of preventable complications,” she said.

Drawing comparisons between both contexts, Okafor argued that while Nigeria and Africa face challenges rooted in institutional weakness and underdevelopment, the United States struggles with fragmentation and policy inconsistency.

According to her, the common thread across both systems is the absence of a coherent, enforceable framework that ensures accountability and continuity of care.

She noted that addressing maternal mortality requires more than reactive measures such as litigation, stressing the need for proactive institutional reforms that embed accountability within healthcare systems.

Okafor also emphasised the role of federal and administrative mechanisms in driving reform, particularly in the United States, where agencies have the capacity to enforce standards through funding conditions and regulatory oversight.

At the same time, she maintained that Nigeria and African countries must prioritise legal and policy reforms that move maternal health from a discretionary policy issue to a binding obligation.

For her, the path forward lies in aligning legal frameworks with institutional capacity, ensuring that rights are not only recognised but effectively enforced.

“Maternal health must be treated as a legal obligation that the state is duty-bound to respect, protect, and fulfil,” she said, adding that meaningful progress would depend on strengthening accountability systems, improving data collection and transparency, and ensuring sustained investment in healthcare infrastructure and personnel.