Poor-quality maternal health care services in Nigeria: inhumane and untenable

Every day, 159 women die due to preventable pregnancy-related causes in Nigeria (World Health Organisation, 2015). These deaths are by far too many and make Nigeria one of the most dangerous places on earth for a woman to give birth. With the use of quality maternal health care, most of these deaths are preventable. However, complex networks of factors prevent women from using maternal healthcare services, including but not limited to poor quality of care(Ajayi & Akpan, 2017). Although there has been a sustained effort at expanding access to maternal and child health in Nigeria, available evidence suggests that this alone does not improve outcomes (MacPherson, Lalloo, Webb, & et al., 2014). Increasing the proportion of births that happen in health facilities has not translated into reductions in maternal mortality in Nigeria (Ezegwui et al., 2013). A conditional cash transfer programme (named Janani Suraksha Yojana) in India, which has increased access to health facility birth for more than 50 million women, has not improved maternal or child survival (Ng et al., 2014).

High-quality maternal healthcare has become elusive for most women in Nigeria. Poor-quality maternal healthcare puts women’s live at risk and erodes people’s trust (Ghebreyesus, 2018). Besides this, it is also ineffective, wasteful, and unethical. In contrast, high-quality maternal health inspires people’s trust and guarantees women’s live. A newly published study by Margaret Kruk and colleagues in The Lancet shows that poor quality of care is responsible for half of maternal deaths in Low and Middle-Income Countries (Kruk et al., 2018 et al., 2018). The current situation of many avoidable maternal deaths without accountability in Nigeria is untenable. Nigeria women deserve a quality maternal health care, which is safe, people-centred, timely, fair, integrated and efficient. There is an urgent need to invest in high-quality health systems and make such systems accountable to the people through legislation, education of women about their rights, regulation, transparency and greater public participation.

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The reason why quality maternal health care is not at the forefront of policy discourse is political. Quality maternal healthcare is impossible without a proper accountability system that is fair and balanced. Sub-Saharan African countries like South Africa (Matsoso, Hunter, & Brijlal, 2018) and Tanzania (Yahya & Mohamed, 2018) have taken the lead in implementing quality improvement and accountability systems, which have received universal commendations. The question remains, when will Nigeria follow?


Ajayi, A. I., & Akpan, W. (2017). Who benefits from free institutional delivery? Evidence from a cross sectional survey of north central and southwestern Nigeria. BMC Health Services Research, 17(1), 620.

Ezegwui, H. U., Onoh, R. C., Ikeako, L. C., Onyebuchi, A., Umeorah, J., Ezeonu, P., & Ibekwe, P. (2013). Investigating maternal mortality in a public teaching hospital, Abakaliki, Ebonyi State, Nigeria. Annals of medical and health sciences research, 3(1), 75-80.

Ghebreyesus, T. A. (2018). How could health care be anything other than high quality? The Lancet Global Health.

Kruk, M. E., Gage, A. D., Joseph, N. T., Danaei, G., García-Saisó, S., & Salomon, J. A. (2018). Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries. The Lancet.

MacPherson, P., Lalloo, D. G., Webb, E. L., & et al. (2014). Effect of optional home initiation of hiv care following hiv self-testing on antiretroviral therapy initiation among adults in malawi: A randomized clinical trial. Jama, 312(4), 372-379. doi:10.1001/jama.2014.6493

Matsoso, M. P., Hunter, J. R., & Brijlal, V. (2018). Embedding quality at the core of universal health coverage in South Africa. The Lancet Global Health.

Ng, M., Misra, A., Diwan, V., Agnani, M., Levin-Rector, A., & De Costa, A. (2014). An assessment of the impact of the JSY cash transfer program on maternal mortality reduction in Madhya Pradesh, India. Global Health Action, 7(1), 24939.

World Health Organisation. (2015). World health statistics 2015: World Health Organization.

Yahya, T., & Mohamed, M. (2018). Raising a mirror to quality of care in Tanzania: the five-star assessment. The Lancet Global Health.

Fecha de publicación: 19/10/2018

  • Adesola Roseline Alaran

    This writeup is indeed true, and something really needs to be done. You are welldone

  • Vincent

    Healthcare service delivery is generally untenable. Increasing maternal and infant mortality are just symptoms of broad based challenges facing the health sector. Anyway, your submission on the issue of maternal mortality is apt and appropriate.

  • Lara Adekanbi

    Improvement of maternal health care is part of the millennium goals which was popular in Nigeria around 2008. This article shows nothing has improved about maternal health care and it is saddening. However it has created awareness about the problem and that is helpful.