Maternity Health Services In Nigeria Are Failing Women: 4 Steps To Better Care

Nigeria faces one of the world’s highest maternal mortality rates. Around 1,047 women die for every 100,000 live births, far above the African regional average of about 531 deaths per 100,000. This highlights the fact that not all women are getting maternal healthcare.

Reasons include:

• differences in access to healthcare between geographical regions

• socio-demographic factors such as education, poverty, age and limited decision-making power within households

• religious affiliation, which in some communities shapes health-seeking behaviour

• limited exposure to health information

• poverty and unemployment

• a lack of health insurance.

Nigeria has implemented several maternal health programmes over the past two decades. The National Integrated Maternal, Newborn and Child Strategy, Midwives Service Scheme and Free Maternal and Child Health Programmes were designed to increase skilled birth attendance, improve access to antenatal and postnatal care, and reduce financial barriers to maternal health services.

But progress in reducing maternal deaths has been uneven across Nigeria. Maternal mortality in the north-east and north-west exceeds 1,000 deaths per 100,000 live births, far higher than rates in southern regions of the country. Many women still do not receive essential maternal health services. For example, only 47.8% of women reported delivering with a skilled birth attendant, and millions of women have limited access to regular antenatal care.

The challenge is no longer about identifying the problem. It is about removing the real barriers Nigerian women face.

We are global public health researchers with a focus on maternal health systems in low- and middle-income countries.

Our recent published policy brief highlighted why many women in Nigeria aren’t using maternity services. Our findings suggest that there are four practical shifts that the Nigerian government could make to improve the use of maternity services across Nigeria. These are:

• region-specific interventions

• increasing the coverage of services so that they’re closer to where women live

• removing financial barriers to care

• using digital capabilities to overcome gaps in services.

Read more: Nigeria must improve health services for mothers and babies: here’s what can change

Four interventions that can make a difference

1. Target regions differently

Maternal health policies often take a national approach, but Nigeria is not uniform. Northern and some southern regions face different cultural, religious and geographic barriers. Government policies therefore need to target specific barriers in different regions. For example, improving transport and health facility access in rural areas, expanding community-based maternal services, and strengthening culturally appropriate health education programmes.

Such policies would typically be developed by Nigeria’s Federal Ministry of Health in collaboration with state governments, local health authorities and community organisations. Regional inequalities in maternal death have shown why a uniform policy approach is ineffective. For example, skilled birth attendance is far lower in the north-west than in southern regions.

The Federal Ministry of Health should empower the state governments to:

• work with the religious and traditional leaders to promote skilled birth attendance

• engage community influencers to counter harmful norms

• train health workers in culturally sensitive care

• strengthen primary healthcare services in underserved districts.

When communities trust the system, they use it.

2. Take services closer to women

Distance remains a barrier, especially in rural areas. Many women cannot travel long distances while pregnant. In many parts of Nigeria, a health facility may be more than 5-10 kilometres away, and poor roads, limited transport and travel costs make it difficult to reach care.

Mobile health clinics can bridge this gap. They bring antenatal care, family planning and basic obstetric services directly to remote communities. These clinics can be established and operated by state ministries of health and local government health authorities. Though there are mobile clinics in Nigeria currently, there ought to be more.

Outreach teams dedicated to maternal health specifically and including trained midwives, nurses, community health extension workers, volunteer community health workers, supported by local primary healthcare staff should:

• provide health education in local languages

• offer on-the-spot referrals

• use community health workers to track pregnancies early.

Care that comes closer to women increases uptake, as seen in western Kenya.

Read more: What mothers told me about Nigeria’s free maternal health services

3. Remove financial barriers

Out-of-pocket payments still prevent many Nigerian women from seeking care. Health insurance coverage remains low. Fewer than 10% of Nigerians are currently covered by any form of health insurance, leaving the majority of households to pay directly for services. This is despite the fact that it was made mandatory for all Nigerians and legal residents in 2022.

Maternal health is meant to be free. But the policy isn’t implemented consistently.

Three reforms are critical:

• expand health insurance coverage for maternity service

• enforce policies that prevent informal or hidden charges

• introduce targeted financial incentives such as vouchers or conditional cash transfers for poor women.

These reforms would require coordinated action across Nigeria’s federal, state and local health systems, which jointly oversee healthcare financing and service delivery.

Evidence from other low- and middle-income countries shows that financial incentives increase service use. When cost is removed, utilisation rises.

Long-term economic empowerment of women is equally important. Women with stable incomes are more likely to seek care.

4. Use digital health to widen access

Nigeria’s digital penetration is growing rapidly. More than 100 million Nigerians use the internet, representing about 45% of the population. Mobile phone penetration exceeds 80% of the population. This creates an opportunity to create digital platforms that:

• send appointment reminders

• provide pregnancy education

• support teleconsultations

• use artificial intelligence tools to improve risk screening.

Read more: HIV in Malawi: digital filing system saved lives and boosted care – research

Digital health will not replace physical services. But it can reduce delays, improve awareness and connect women to care earlier.

Rwanda has integrated AI into healthcare through digital platforms that support remote consultations and clinical triage. Tools such as the Babyl telemedicine platform use AI-assisted systems to help nurses assess symptoms, guide treatment decisions and connect patients to doctors through mobile phones, expanding access to care in rural areas. This shows what is possible when technology is used strategically. Nigeria can adapt similar models for maternal health.

Read more: Family planning helps prevent HIV from spreading: why are many Nigerians not using contraception?

Way forward

Nigeria does not need more policy documents. It needs targeted implementation.

First, federal and state governments must align efforts. Nigeria already has national institutions coordinating maternal health policy, including the Federal Ministry of Health and Social Welfare and the National Primary Health Care Development Agency. But because health services are delivered largely by state and local governments, implementation varies widely. Maternal health policies should be state-specific but nationally coordinated and adapted to state-specific realities.

Second, funding must prioritise primary healthcare and community engagement. Investments should focus on where utilisation is lowest.

Third, monitoring systems must improve. Data should guide decisions at local levels. Programmes that work should be scaled. Those that fail should be redesigned.

Finally, women themselves must be part of policy design. Solutions imposed from above rarely succeed. Improving maternity service use is not only a health goal. It strengthens families, communities and the economy.

The next step is clear: implement smarter, targeted policies that remove barriers and bring care closer to every woman.

Obasanjo Bolarinwa works for York St. John University, United Kingdom.

Dr Rebecca Tadokera works for York St John University.