Maternal and child health refers to the health and well-being of mothers, infants, and children, with a focus on the care they receive before, during, and after childbirth. It includes services and interventions that ensure safe pregnancy and delivery, promote healthy growth and development, and prevent or treat illnesses and conditions that can affect mothers and their children. This newsletter explores the evolution of maternal and child health in Nigeria, highlighting key milestones, policies, and ongoing challenges.
The journey of maternal and child health development in Nigeria has been both intricate and multifaceted, reflecting a blend of progress and enduring challenges. Since its independence in 1960, Nigeria has worked to enhance the health and well-being of mothers and children by prioritizing accessible, quality healthcare, acknowledging its pivotal role in the nation’s overall development.
In the early years following independence, Nigeria’s healthcare focus was primarily on combating infectious diseases, with limited attention given to maternal and child health. During this period, health services were centralized, and access to quality care for mothers and children was inadequate, especially in rural areas. It was not until the late 1970s that maternal and child health began to receive more focused attention, largely due to Nigeria’s adoption of the Primary Health Care (PHC) approach. The PHC model, influenced by the Alma-Ata Declaration of 1978, emphasized accessible and community-based health services, which included maternal and child health as one of its key components. This shift marked the beginning of more structured efforts to address the health needs of mothers and children.
The 1990s saw the introduction of specific programs aimed at improving maternal and child health in Nigeria. One notable initiative was the Safe Motherhood Initiative, launched to reduce the high rates of maternal mortality by improving access to quality obstetric care. This initiative highlighted the critical need for skilled birth attendants and emergency obstetric services, particularly in rural areas where maternal deaths were most prevalent. Additionally, to protect children from vaccine-preventable diseases, the Expanded Programme on Immunization (EPI) was introduced significantly contributing to reductions in child mortality rates. These programs were supported by the National Health Policy of 1988, which provided a framework for integrating maternal and child health into broader health sector strategies.
Despite these efforts, Nigeria continued to face significant challenges in improving maternal and child health throughout the 2000s. High rates of maternal and child mortality remained a pressing concern, driven by factors such as inadequate healthcare infrastructure, insufficient skilled healthcare workers, and socio-economic barriers that limited access to care. In response to these challenges, Nigeria committed to the United Nations Millennium Development Goals (MDGs), which included specific targets for reducing child mortality and improving maternal health. This commitment led to increased international support and funding, which helped to expand maternal and child health programs across the country. However, progress towards the MDG targets was uneven, and Nigeria struggled to achieve the desired reductions in mortality rates by the 2015 deadline.
In recent years, Nigeria has continued to prioritize maternal and child health, guided by a series of strategic initiatives and policies. The National Health Act of 2014 was a significant milestone, establishing a legal framework for healthcare provision that includes specific provisions for maternal and child health services. The National Strategic Health Development Plan further outlines strategies to improve maternal and child health, such as increasing the number of skilled birth attendants, expanding immunization coverage, and enhancing access to family planning services. Nigeria’s commitment to the Sustainable Development Goals (SDGs) has also reinforced these efforts, with a renewed focus on reducing maternal and child mortality and improving access to quality healthcare.
Notwithstanding these advancements, Nigeria continues to grapple with significant challenges in achieving optimal maternal and child health outcomes. Healthcare access remains uneven, particularly in rural areas, where gaps in service delivery and infrastructure are pronounced. Limited funding, a shortage of skilled healthcare professionals, and socio-cultural barriers further hinder progress. Additionally, widespread poverty and low levels of education among women in many regions intensify the challenges of accessing timely and adequate care.
These factors have led to Nigeria having one of the highest maternal mortality rates in the world, with approximately 576 deaths per 100,000 live births as of 2023 (UNICEF). This statistic reflects the severe challenges that pregnant women in Nigeria face, including limited access to quality prenatal and delivery care, insufficient skilled birth attendants, and inadequate emergency obstetric services. The leading causes of maternal deaths include hemorrhage, infections, hypertensive disorders, and complications from unsafe abortions. These conditions are often preventable with timely and effective healthcare, but barriers limit progress. . Only about 43% of births in Nigeria are attended by skilled health personnel, which is far below the global target and highlights the disparities in access to skilled care, especially in rural areas.
In tandem with Maternal healthcare, Child health in Nigeria also presents a concerning picture, with the country having one of the highest under-five mortality rates globally. Currently, the under-five mortality rate stands at approximately 114 deaths per 1,000 live births, meaning that about 1 in 10 Nigerian children do not survive to their fifth birthday. The infant mortality rate is similarly high, at around 54 deaths per 1,000 live births. Major causes of death among infants and young children include preventable conditions such as malaria, pneumonia, diarrhea, and neonatal complications like birth asphyxia and sepsis. The high rates of child mortality are exacerbated by factors such as malnutrition, inadequate access to clean water and sanitation, and poor healthcare services. For instance, malnutrition remains a critical issue, with around 37% of children under five being stunted, 7% wasted, and 22% underweight. These figures indicate that a significant proportion of Nigerian children suffer from chronic malnutrition, which adversely affects their growth and development.
To mitigate child mortality rate, Immunization is a key component, however, Nigeria’s immunization coverage remains sub-optimal. The coverage for the third dose of the DTP (Diphtheria, Tetanus, and Pertussis) vaccine is about 57%, which is considerably below the 90% threshold recommended by the World Health Organization (WHO) to achieve herd immunity and prevent disease outbreaks. Following exclusive breastfeeding which is essential for providing infants with the nutrients they need for healthy growth and protecting them against common childhood illnesses. But only about 29% of infants are exclusively breastfed for the first six months of life, which is below the WHO recommendation of 50%. Exclusive breastfeeding is essential for providing infants with the nutrients they need for healthy growth and protecting them against common childhood illnesses.
Access to maternal and child health services in Nigeria is uneven, with significant disparities between urban and rural areas and across different regions of the country. The northern regions, particularly the Northeast, have some of the worst health indicators due to factors such as ongoing conflict, poor infrastructure, and socio-economic challenges. The healthcare system in Nigeria faces numerous obstacles, including inadequate infrastructure, insufficient funding, and a lack of skilled healthcare workers. Many healthcare facilities, especially in rural areas, are poorly equipped and lack essential supplies, which compromises the quality of care provided to mothers and children.
To address these challenges, the Nigerian government has developed several policies and strategic plans aimed at improving maternal and child health. Key initiatives include the National Strategic Health Development Plan and the Reproductive, Maternal, Newborn, Child, Adolescent and Elderly Health Plus Nutrition (RMNCAEH+N) platform. These policies focus on expanding access to quality healthcare services, increasing the number of skilled birth attendants, and enhancing immunization coverage. The National Health Act of 2014 was also a significant milestone, as it established a legal framework for healthcare provision that includes specific provisions for maternal and child health services. However, despite these efforts, the implementation of these policies faces challenges such as inadequate funding, weak health systems, and poor governance. There is also a need for better data collection and monitoring to inform decision-making and ensure that resources are effectively allocated.
Furthermore, International support and partnerships have played a crucial role in Nigeria’s efforts to improve maternal and child health. Organizations such as UNICEF, WHO, and various non-governmental organizations have provided funding, technical assistance, and capacity-building support. These partnerships have been instrumental in supporting maternal and child health programs, expanding immunization coverage, and promoting best practices in maternal and child care. However, achieving substantial progress will require a sustained commitment to strengthening the health system, addressing socio-economic barriers, and ensuring that healthcare services are accessible, affordable, and of high quality for all. The current state of maternal and child health in Nigeria reflects a complex interplay of progress and persistent challenges. High rates of maternal and child mortality, inadequate access to quality healthcare, and significant disparities in health outcomes continue to pose major obstacles. To improve the health of mothers and children in Nigeria, it is essential to address these systemic barriers, enhance the implementation of health policies, and ensure that health services reach the most vulnerable populations. By prioritizing the health and well-being of mothers and children, Nigeria can make significant strides towards achieving better health outcomes and improving the overall quality of life for its citizens. Looking to the future, Nigeria’s efforts to improve maternal and child health must continue to focus on expanding access to quality services, particularly in under served areas. Strengthening the health system, improving data collection, and ensuring effective implementation of health policies are crucial steps towards achieving sustainable improvements. Community engagement and education are also essential components, as empowering communities with knowledge and resources can promote healthy practices and encourage early healthcare seeking behavior.
In conclusion, the development of maternal and child health in Nigeria reflects a journey of both progress and persistent challenges. While significant strides have been made, particularly in expanding access to care and implementing targeted health programs, much work remains to be done. By addressing the systemic barriers and continuing to prioritize the health of mothers and children, Nigeria can make further progress towards ensuring that every mother and child has the opportunity to live a healthy and fulfilling life.
