Devpro Resource Centre


A strategy to reduce maternal and neonatal deaths in Nigeria

© UNICEF/NYHQ2007-0197/Nesbitt
Imrana Musa, 10, leads a toddler, as well as an infant carried by her mother, to a fixed immunization post in the northern state of Katsina.

Context and challenge: Poverty, demographic pressures and insufficient investment in public health care inflate levels and ratios of maternal and neonatal mortality

Nigeria is Africa’s most populous country, with 148 million inhabitants in 2007. There were almost 6 million births there in 2007 – the third highest number in the world, behind India and China – and a total fertility rate of about 5.4. Nigeria is also known for its vast oil wealth. Nonetheless, poverty is widespread; according to the World Development Indicators 2007, published by the World Bank, more than 70 per cent of Nigerians live on less than US$1 per day, which impairs their ability to afford health care. Poverty, demographic pressures and insufficient investment in public health care, to name but three factors, inflate levels and ratios of maternal and neonatal mortality. The latest United Nations inter-agency estimates place the 2005 average national maternal mortality ratio at 1,100 deaths per 100,000 live births, and the lifetime risk of maternal death at 1 in 18. When viewed in global terms, the burden of maternal death is brought into stark relief: Approximately 1 in every 9 maternal deaths occurs in Nigeria alone.

The women who survive pregnancy and childbirth may face compromised health; studies suggest that between 100,000 and 1 million women in Nigeria may be suffering from obstetric fistula. Disparities in poverty and health among Nigeria’s numerous ethno-linguistic groups and states are marked. Poverty rates in rural areas – estimated at 64 per cent in 2004 – are roughly 1.5 times higher than the urban-area rate of 43 per cent. Low levels of education – especially among women – and discriminatory cultural attitudes and practices are barriers to reducing high maternal mortality rates. High rates of adolescent births are commonplace across Nigeria, exposing girls and women of reproductive age to numerous health risks.

© UNICEF Nigeria/2007/Tayo
A community heath extension worker provides advice to mothers on child care during her house visits.

Action: A national, phased, high-impact strategy to address maternal, neonatal and child health challenges

Given these complex realities, developing strategies to accelerate progress on maternal and newborn health remains a considerable challenge. Nevertheless, the Government of Nigeria, together with international partners, is attempting to meet this challenge. In 2007, it began implementing a national Integrated Maternal, Newborn and Child Health Strategy to fast-track high-impact intervention packages that include nutritional supplements, immunization, insecticide-treated mosquito nets and the prevention of mother-to-child transmission of HIV. The strategy is being rolled out in three phases, each lasting three years, and has been designed along the lines of the continuum-of-care model to strengthen Nigeria’s decentralized health system, which operates at the federal, state and local levels. In the initial phase, covering 2007–2009, the key focus is on identifying and removing bottlenecks, while delivering a basic package of services using community-based and family-care strategies. A sizeable proportion of expenditure will go towards artemisinin-based combination therapy to combat malaria in women, children, and newly recruited and trained health workers, particularly in rural areas. As basic health care improves, it is anticipated that the demand for clinical services will increase. The second and third phases of the integrated strategy will place greater emphasis on building health infrastructure. Throughout nine years, the strategy aims to revitalize existing facilities, construct clinics and hospitals, and create incentives – such as dependable salaries, hardship allowances and performance-based bonuses – that will help retain skilled health professionals in Nigeria’s health system.

© UNICEF/NYHQ2007-0342/Nesbitt
A newborn sleeps in her crib at the Lagos State University Teaching Hospital in the city of Lagos.

Opportunities: Health-system improvements have the potential to set a new course for meeting Millennium Development Goals 4 and 5

The Integrated Maternal, Newborn and Child Health Strategy – if implemented in full and on time – can markedly improve maternal and newborn health. Together with this package, the country has recently passed the National Health Insurance Scheme, which integrates the public and private health sectors to make health care more affordable for Nigerians. If the government passes the National Health Bill – which is currently before the legislature – a direct funding line for primary health care will become available. These health-system improvements have the potential to set a new course for meeting Millennium Development Goals 4 and 5 in Africa’s most populous nation.



To learn more

UNICEF, The State of the World’s Children 2009: Maternal and newborn health. | PDF English | French | Spanish

UNICEF Nigeria | website

UNFPA/EngenderHealth, Obstetric Fistula Needs Assessment Report: Findings from nine African countries, 2003. | access report

WHO, Neonatal and Perinatal Mortality: Country, regional and global estimates 2004. | access report

Wall, L. Lewis, ‘Dead Mothers and Injured Wives: The social context of maternal morbidity and mortality among the Hausa of northern Nigeria’, Studies in Family Planning, vol. 29, no. 4, December 1998.


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