Maternal Health Task Force

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More Women in Nigeria Are Using Maternal Health Services – But Gaps Persist

By: Sarah Hodin, Project Coordinator II, Women and Health Initiative, Harvard T.H. Chan School of Public Health

In 2015, an estimated 58,000 women in Nigeria died from pregnancy or childbirth-related causes, accounting for almost one-fifth of global maternal deaths. Despite adoption of maternal health policies and interventions, Nigeria has the fourth highest maternal mortality ratio in the world at roughly 814 deaths per 100,000 live births. Data have indicated low coverage of essential maternal health services and limited progress over time.

A recent paper published in the MHTF-PLOS Collection, “Neglected Populations: Decreasing Inequalities & Improving Measurement in Maternal Health,“ explored maternal health care utilization among women in Lagos State, western Nigeria. The researchers used a structured, interviewer-administered questionnaire to collect sociodemographic data and information about where, with whom and why women received antenatal, delivery, postnatal, family planning and child health services. While there have been measurable improvements related to antenatal and intrapartum care, more progress along the continuum of care—especially for family planning and during the postpartum period—is needed.

Antenatal care

Among women who received antenatal care (ANC), 47.8% initiated care during the second trimester, 39.1% did so during the first trimester and the remaining 13% sought ANC during the last trimester. Roughly two-thirds of women who received ANC attended at least four visits. The majority of women reported seeking ANC at the health facility only, and about one-third saw a traditional birth attendant (TBA) either alone or in addition to facility-based care.

Place of ANC Percentage of women (n=371)
Health facility only 56.6%
TBA only 17%
Health facility and TBA 17.8%
Did not receive ANC 7.3%
Other 1.3%

The most commonly reported reasons for not attending ANC were financial constraints, not needing care and distance to a facility.

Labor and delivery

Approximately 60% of women delivered in a health facility, more than a quarter delivered with a TBA and the rest gave birth at home, a place of worship or another location.

Place of delivery Percentage of women (n=371)
Public health facility 40.2%
Private health facility 19.7%
TBA 26.7%
Home 7.5%
Church/mosque 4.9%
Other 1.1%

The majority of women who delivered outside of a health facility were attended by a TBA, although some gave birth with a nurse, neighbor or family member.

Non-institutional delivery birth attendant Percentage of women (n=149)
TBA 68.5%
Nurse 14.8%
Neighbor/friend 6.7%
Older woman 5.4%
Mother/mother-in-law 2.7%
Doctor 1.3%
Other relative 0.7%

When asked about the factors that influenced their choices related to place of delivery, women reported several different factors that influenced their choices.

Reasons for choice of place of delivery Percentage of women*
Quality of care 37.5%
Distance from home or work 34.5%
Cost of services 27.5%
Health worker attitude 24.8%
Husband’s preference 21.3%
Other 10.8%

*Women could give multiple responses for this question

Other key findings and next steps

  • Most women receive postnatal care—but only once. 78% of respondents utilized some postnatal care (PNC) during their last pregnancy. Among those women, 58.8% had only one visit and 50.2% went during the fifth or sixth week following delivery.
  • While breastfeeding rates are high, few breastfeed exclusively. 98% of respondents breastfed their babies, 52.9% initiating breastfeeding within 30 minutes of delivery and 31.5% breastfed exclusively.
  • Social determinants cannot be ignored. Consistent with previous studies, factors influencing the likelihood of facility-based maternal health care utilization included maternal and paternal education levels and employment status, age and marital status.
  • A focus on quality throughout the continuum of maternal health care matters for child health. Women who received facility-based ANC, delivery care and PNC were significantly more likely to utilize child health services.

Overall, the researchers found higher levels of maternal and child health service utilization in Lagos State compared to previous data from Nigeria. However, less than a third of respondents received family planning services after delivery, and nearly two-thirds gave birth outside of a facility.

The results of this study illustrate the need to address gaps in maternal health care utilization in Lagos State, Nigeria. Doing so will require attention to social determinants and efforts to improve quality of care.

Browse open access papers from the MHTF-PLOS Collection, “Neglected Populations: Decreasing Inequalities & Improving Measurement in Maternal Health.”

Access resources to learn more about maternal health in Nigeria.

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