By Balikis Kabir

Maternal mortality, which refers to the death of a woman resulting from pregnancy and/or childbirth complications, remains one of the world’s major public health challenges. Over the past two decades, global progress in reducing maternal deaths has been limited, with approximately 287,000 maternal deaths recorded in both 2010 and 2020. Consequently, the global lifetime risk of maternal mortality was estimated at 1 in 210 in 2020. Although total maternal deaths declined to 260,000 in 2023, the global lifetime risk improved only slightly to 1 in 272. In other words, a 15-year-old girl has, on average, a 1 in 272 chance of dying from a maternal cause during her lifetime. 

Given the persistent disparities in healthcare and income across countries, these preventable deaths occur predominantly in low- and middle-income countries, and Nigeria is among the major contributors to global maternal deaths. Several studies have examined maternal health in Nigeria, and the leading factors impacting the situation could be grouped into two interrelated dimensions of access to quality maternal healthcare: availability and affordability. 

According to the 2025 WHO report, approximately 80% of Nigeria’s public health infrastructure is dysfunctional, severely limiting the country’s capacity to provide adequate healthcare services to its population. Consequently, access to healthcare remains highly unequal, with pronounced disparities across socioeconomic groups and geographic locations. Long travel times have been shown to reduce healthcare utilization, delay care-seeking, and worsen health outcomes. 

The cost of healthcare remains a major barrier to accessing maternal healthcare in Nigeria, as most health services are financed through out-of-pocket payments. Health insurance coverage is extremely limited. According to the 2018 NDHS, only 3% of individuals aged 15–49 years were covered by some form of health insurance. The financial burden of maternal healthcare extends beyond direct medical costs. Many pregnant women reduce the number of antenatal care visits due to transportation costs and informal charges imposed by some primary healthcare centers and state-owned hospitals. 

Sustainable Development Goal (SDG) target 3.1 aims to reduce the global maternal mortality ratio to fewer than 70 maternal deaths per 100,000 live births by 2030. However, a decade before this target year, Nigeria ranked among the three countries with the highest maternal mortality ratios, recording 1,047 maternal deaths per 100,000 live births. Although this declined to 993 in 2023, Nigeria still recorded the highest number of maternal deaths globally that year. With approximately 75,000 maternal deaths, the country accounted for more than one-quarter (28.7%) of all estimated maternal deaths worldwide in 2023, making Nigeria one of the least safe places to give birth.

For Nigeria to make meaningful progress toward achieving the maternal health targets of the SDG, coordinated action across multiple sectors is essential. Despite the implementation of numerous policies over the years, maternal health outcomes have shown limited improvement, highlighting the need for comprehensive reforms within the healthcare system. In particular, primary healthcare, which serves as the first point of contact for most pregnant women, especially those in underserved communities, requires urgent revitalization. Many primary healthcare facilities remain inadequately equipped, poorly funded, and critically understaffed, limiting their ability to provide quality maternal healthcare. Addressing these systemic weaknesses is crucial to improving maternal and neonatal outcomes and ensuring equitable access to essential maternal health services.