Nigeria is home to 20% of all maternal deaths in the world — at least 800 of every 100,000 live births lead to the death of the mother. 

With a population of 200 million, public health care in Nigeria is underfunded, health workers are poorly paid, and there is an acute shortage of doctors. 

According to the Journal of Global Health Reports, 1 in 22 Nigerian woman die during pregnancy, childbirth, postpartum, or post-abortion, in contrast to developed countries where the ratio is estimated at 1 in 4,900.

There are also socio-cultural challenges such as delays in making the decision to seek maternal health care; delay in locating and arriving at a medical facility; and delay in receiving skilled pregnancy care when the woman gets to the health facility.

Global Citizen spoke with Dr. Uche Ralph-Opara, Nigeria country representative and senior advisor for systems strengthening at Project HOPE, an international global health and humanitarian organisation, about the challenges and solutions to maternal health care in Nigeria. 

What do you think are the biggest challenges for Nigerian women in accessing maternal health care?

In my opinion, some of the biggest challenges faced by Nigerian women in accessing maternal health care include inequities of accessibility to health services, especially for those in rural communities where health facilities are sparsely distributed; poor health-seeking behaviours, mainly stemming from lack of education and available resources and information, poverty, socio-cultural or religious beliefs, and also affordability of health services.

There's also an inadequate number of skilled health providers and sometimes, women not knowing how to advocate for themselves in formal health care settings; and high numbers of unskilled or traditional birth attendants within the communities prevent women from accessing skilled care in formal settings.

What situations, in your opinion, have created these challenges? 

These challenges over time have been created by various factors including inadequate budgeting for health and health sector financing; unavailability of adequate data and poor use for decision making (in the case of health personnel availability and distribution to ensure equity); and inadequate training of health providers on provision of quality maternal health services.

Also reliance on donor funding for maternal health services, and issues with sustainability of such maternal health programmes; and increasing rates of poverty and high out-of-pocket expenditure for accessing maternal health services.

What do you think are the most efficient ways to solve these challenges? 

Maternal health is a cornerstone for healthy and productive populations.  

If we want to get it right with regards to improving access to maternal health care, we need to increase annual budgets for health and health sector financing. 

As of 2020, the budget for health was slightly above 4% of the total budget, which is still a far cry from the Abuja Declaration [a pledge by African governments to set annual health budgets of at least 15%].  

We must also consider mass media campaigns through various platforms and channels to create awareness on maternal health issues and the need to access health services. 

Engagement of community gatekeepers through advocacy will help in improving knowledge of community leaders on maternal health and correct certain socio-cultural misconceptions, which are barriers to accessing maternal health services in the community.  

Due to the high volume of unregistered traditional birth attendants, it would be a great idea to look through the system and address hindrances to registration. 

We may also scale up health insurance programmes, especially community-based health insurance to reduce out-of-pocket spending and increase access to maternal health services. 

Training and retraining of health workers on provision of quality maternal health services and implementing task shifting and task sharing policies at health facility levels will also help. 

What are the global or regional baseline requirements for equitable maternal health care access? 

The key baseline requirements for equitable access to maternal health services include adequate health budgeting and health sector financing, and an effective maternal health workforce — not only in terms of numbers, but also equitably distributed, well trained and skilled. 

Also, an enabling environment and supportive health systems are critical to ensuring that health workers are willing and able to provide high quality maternal health care.

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