Nigeria is facing alarming maternal health challenges, highlighted by recent statistics from the 2023-24 Nigeria Demographic and Health Survey (NDHS). These findings have ignited significant discussions within the maternal health community, underscoring the need for immediate and effective interventions.
According to the new NDHS, there are promising trends, particularly concerning fertility rates and health facility births. The survey reveals the contraceptive prevalence rate among married women has risen from 16.6% to 20% since 2018. Yet, this is still short of Nigeria’s ambitious target of reaching 27% by 2024 and considerably beneath the global average of 57%. More concerning is the total fertility rate, which has only seen a minor reduction from 5.3 to 4.8 children per woman, representing the most significant decline since the 1990s. Despite these slight improvements, over half of Nigeria's demand for family planning remains unfulfilled, with unmet need climbing from 18.9% to 21%.
Unmet need refers to the gap between women's reproductive intentions and their contraceptive usage. Many women express the desire to avoid pregnancy but are not using any contraceptive method due to various barriers, including lack of access and underlying socio-economic factors. These barriers negatively affect the health of mothers and infants, emphasizing the importance of family planning as it allows for healthier spacing between pregnancies.
The increase of unmet need, from 18.9% to 21%, is attributed to concerted efforts and investments by the Federal Ministry of Health and several partners, including the UNFPA and USAID/Nigeria. Investment strategies have focused on enhancing access to family planning technology and resources. Notably, the Bill & Melinda Gates Foundation (BMGF) has been instrumental by supporting advocacy efforts aimed at securing commitments from state governments to fund family planning as part of broader maternal health services. It seems paradoxical; successful family planning programs have led to this growing unmet need, indicating there’s still much more groundwork to cover.
At the national level, it's imperative for Nigeria to concentrate on the pivotal role of family planning within maternal health. Recent government initiatives have introduced several new health reforms directed at addressing these unmet needs. Tackling Nigeria’s persistent high maternal mortality rates demands consistent investment in sustainable family planning interventions integrated within maternal health programs. Such integration remains pivotal to reversing the current grim death statistics.
Forecasting events, the upcoming Biennial Family Planning Conference organized by the Association for the Advancement of Family Planning (AAFP) will provide a platform for addressing these unmet needs. This year’s conference, scheduled for December 4-6, 2024, will discuss strategies to tackle family planning challenges sustainably and cost-effectively. Current market analyses, including those by the development Research and Projects Centre (dRPC) and Nigeria Health Watch, have noted significant price increases for contraceptive products as barriers to access family planning services, indicating the urgent need for focused discussions at the conference.
The Health Sector Strategic Blueprint for 2023-2027 and the Nigeria Health Sector Renewal Investment Initiative aim to provide comprehensive mechanisms for scaling up fundamental health services, including reproductive health care. Despite the strategies proposed, Nigeria must remain steadfast in prioritizing family planning within policy and budgetary initiatives. Allocations should be made to fulfill commitments made under FP2030, particularly the commitment to earmarking 1% of the health budget for family planning.
Meanwhile, another pivotal initiative has gained attention. On November 8, 2024, Nigeria’s Minister of Health and Social Welfare, Prof. Muhammad Ali Pate, announced free cesarean sections for women who require them but cannot afford the costs. This initiative, launched alongside the Maternal Mortality Reduction Initiative, aims to tackle the nation’s alarming maternal and neonatal mortality rates—some of the highest globally. With plans to recruit around 120,000 additional health workers to bolster primary health care, the initiative could have far-reaching effects on maternal health outcomes.
Prof. Pate stated, “No woman should die because she can’t afford a C-section.” This statement encapsulates the essence of the initiative, which is exclusively for women facing emergency situations where cesarean delivery is necessary and who lack the financial means.
According to Tashikalmah Hallah, Senior Adviser Media and External Relations to the Minister, the initiative targets only those urgent cases evaluated by accredited government hospitals. Social welfare departments within these hospitals will assess the need for cesarean deliveries among expectant mothers.
The World Health Organization (WHO) and the UN Children’s Fund (UNICEF) stress the urgency of improving maternal health conditions. With Nigeria experiencing approximately 1,047 maternal deaths per 100,000 live births, addressing these rates is imperative. A staggering proportion—over 50%—of maternal deaths is attributable to just 172 local government areas, making targeted interventions even more necessary.
Cesarean sections, considered surgical procedures to deliver infants through abdominal incision, are often employed when vaginal deliveries are deemed risky. The financial burden of such procedures can be prohibitive, averaging around 60,000 Naira (nearly $36) at local hospitals, hence the push for free services being implemented now.
This dual approach facing Nigeria—enhancing access to family planning and reducing maternal mortality via emergency, cost-free C-sections—rounds out the country’s urgent bid to improve maternal health outcomes. The initiatives feed directly off each other; improved family planning reduces the overall number of pregnancies and thereby the number of emergency situations where cesareans may be necessary.
The convergence of these two important national health strategies signifies hope for improvements in Nigeria’s maternal health statistics. Nevertheless, the challenges are substantial, and sustained efforts, along with collaborative partnerships among governmental bodies, civil society, and health professionals, remain key for potential success.
These initiatives not only address urgent health care needs but also aim to create more equitable healthcare access across the nation. Each measure implemented currently lays the groundwork for long-term improvements, promoting healthier futures for mothers and their children alike. Each positive step taken within this framework is not merely another statistic but rather impacts real lives, aiming to transform Nigeria’s maternal health narrative.
