Health
Maternal deaths won’t fall without regular antenatal care, physicians say
Medical experts have said it will be practically impossible to reduce Nigeria’s high maternal mortality rate unless pregnant women across the country, including those in hard-to-reach areas, have access to regular antenatal care and hospital delivery.
The experts advised pregnant women with non-communicable diseases such as heart disease, hypertension, diabetes, and sickle cell disorder to register for antenatal care in teaching hospitals where they can get specialist care.
Speaking in exclusive interviews with PUNCH Healthwise on ways to reduce maternal deaths in Nigeria, the physicians stated that starting antenatal care between six and eight weeks helps reduce the risks of complications, promotes a healthy pregnancy experience, and improves health outcomes for both mother and child.
Nigeria has one of the highest maternal mortality rates in the world, with an estimated 512 deaths per 100,000 live births according to the Nigeria Demographic and Health Survey 2018.
A Consultant Paediatrician and Head of the Department of Paediatrics at the Federal Teaching Hospital, Dr Kelechi Ebisike, identified regular antenatal care as one of the most important interventions.
“The key thing is antenatal care. So, if people can subscribe to it and follow the obstetrician’s guidelines in going through the care, it will go a long way in reducing maternal death,” Ebisike said.
According to him, women in rural communities were particularly vulnerable because some did not attend antenatal clinics and only sought hospital care when complications became severe.
“What contributes to that is that a lot of women from, of course, rural communities, don’t go for antenatal care. They will just stay at home, deliver at home. They don’t even go for immunisation and all that.
“It is only when there is a complication that is beyond what a traditional birth attendant can do that they now come in emergency to the tertiary or general hospitals,” he said.
The Minister of State for Health and Social Welfare, Dr Iziaq Salako, said Nigeria contributes about 14 per cent of global maternal deaths and nine per cent of global under-five deaths.
Salako disclosed this in his inaugural address during the second day of the 2025 Joint Annual Review Meeting in Abuja, with the theme, “All hands, one mission: Bringing Nigeria’s health sector to light.”
“Nigeria still accounts for approximately 14 per cent of global maternal deaths and nine per cent of global under-five deaths, despite representing only 2.6 per cent of the world’s population,” he noted.
Ebisike, however, acknowledged that some women would continue to patronise traditional birth attendants despite efforts to encourage hospital deliveries.
He therefore advocated the training and retraining of traditional birth attendants to enable them to recognise danger signs and provide safer care while ensuring timely referral.
“Many of them, whatever you do, they will still not go, but they will go to their traditional birth attendant. So, the number one thing to do is also to train and retrain those traditional birth attendants as a way they can be given some training that can enhance or improve their care and reduce maternal deaths that occur from their end,” he said.
The paediatrician also stressed the need for healthcare workers at primary healthcare facilities to understand their limitations and promptly refer women with high-risk pregnancies to specialists.
He identified hypertension in pregnancy, elevated blood sugar, multiple pregnancies and diabetes as some conditions requiring specialist attention.
“Some patients may be going for antenatal care in a maternity centre, in a primary healthcare centre. Sometimes they have some complications, like hypertension in pregnancy, elevated sugar in pregnancy, multiple pregnancy, maybe a woman that has diabetes and she’s pregnant.
“Some of those are supposed to be seen by specialists, the obstetricians. So they are supposed to refer them, but most times, some of them, they just think they know. They will just be prescribing antihypertensives, prescribing this and that until the pregnancy becomes complicated, and those can lead to maternal death,” Ebisike said.
He urged primary healthcare providers to recognise when a patient’s condition was beyond their capacity and refer such women to general or tertiary hospitals early enough for specialist intervention.
“For people at the primary healthcare level to know their limit and know when they should refer to a general hospital or a tertiary hospital so that the specialist can take the right action,” he added.
According to him, delays at tertiary healthcare facilities could also contribute to maternal deaths, particularly when women arrived with life-threatening complications such as convulsions.
He explained that women who arrived at hospitals late, sometimes unconscious or already convulsing, could require immediate interventions, including emergency Caesarean section.
“And again, when they come to tertiary centres, sometimes they refer them—maybe a woman is already convulsing, she’s pregnant, close to delivery, and she’s convulsing. Some of them are unconscious, and those are the sort of things that lead to death,” he said.
Ebisike noted that shortages of emergency drugs, equipment, and skilled manpower could further delay the treatment of women who arrived at hospitals with complications.
“Sometimes when they come to tertiary hospitals, there is no equipment, drugs, scarce emergency drugs, and it can delay. Sometimes it is the last section that will be the fastest way to deliver the baby and save the mother.
“But because there may be limited manpower or limited drugs, emergency drugs, and skills, it can now affect the outcome, and the woman may die in such situations,” he said.
The consultant, however, pointed to ongoing Federal Government interventions aimed at improving access to emergency obstetric care, including the Comprehensive Emergency Obstetric and Newborn Care programme.
He explained that under the intervention, women who present with pregnancy-related emergencies can access emergency Caesarean sections without having to pay for the procedure.
“There is this Comprehensive Emergency Obstetric and Newborn Care (CEMONC)—It’s just some programme on the ground where Caesarean sections are done free of charge for women who come in with complications, emergencies, whatever emergency.
“If you just come and it’s confirmed that the emergency that is related to pregnancy is free, it’s free. Federal government takes care of it, right and on,” he said.
Ebisike said awareness of such interventions could encourage women and families in rural communities to seek hospital care when complications arise.
“When people in the rural places now know that when they come, they will access care for free, they are encouraged to refer. They also bring their patients,” he added.
He further identified the Federal Government’s Maternal Mortality Reduction Intervention Initiative, MAMII, as another intervention aimed at reducing preventable maternal deaths.
Also speaking, another physician, Dr Sadiya Adam, noted that antenatal services had served more women and children, encouraging mothers to embrace the opportunities they offered.
Adam said, “Both state and federal governments, alongside donor agencies, have endowed a lot of programmes to ensure safe delivery. It’s highly imperative for more women to continue to embrace this service. In my years of practice, I have seen early antenatal saves lives.”
She called for concerted efforts among stakeholders, adding, “Traditional and religious leaders should take ownership since they are the closest to families. Fathers have a role to play in ensuring their wives access ANC services.”
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