For years, Nigeria has ranked among the countries with the highest maternal mortality rates in the world. While global maternal deaths have declined significantly since 1990, Nigeria’s progress has been slow and uneven. The figures are alarming—but they only scratch the surface. A woman’s chances of surviving childbirth in Nigeria often depend on where she lives, her age, her income level, and the kind of healthcare she can access. Whether the data comes from private hospitals/clinics or overburdened public hospitals also affects how these numbers are reported.

Another critical question is whether the sample sizes used in many studies—sometimes just a few hundred or a thousand cases—are truly representative of a country with over 60 million women. Can such small samples realistically capture the national picture? These concerns highlight the need to look beyond the statistics and examine the deeper social, economic, and methodological issues driving maternal mortality in Nigeria.

The Changing Face of Maternal Mortality (1990–Present)
In 1990, Nigeria’s maternal mortality ratio (MMR) was estimated at 1,350 deaths per 100,000 live births—a figure that dwarfed the global average. Over the next three decades, official estimates showed a gradual decline: by 2015, the MMR had dropped to 814, and by 2023, it stood at 993 per 100,000 live births, according to Macrotrends data.

Yet, these national averages mask wild fluctuations and persistent high-risk pockets. For instance, the Lagos University Teaching Hospital reported an increase from 2,211 deaths per 100,000 in 2007 to 3,555 in 2019, a 3.4% annual rise. Other tertiary hospitals have recorded ratios as high as 7,234 deaths per 100,000 live births in specific periods.

There is no doubt that women are dying during childbirth at a very high rate in Nigeria, however many questions remain unanswered by research. What do these women have in common and why are they dying?

How Are These Numbers Gathered? The Limits of Hospital-Based Studies
Most prominent studies on maternal mortality in Nigeria are hospital-based, relying on retrospective reviews of medical records in tertiary teaching hospitals. Researchers comb through delivery registers, mortuary logs, and case files to identify maternal deaths, often focusing on women who died in or were referred to these institutions.

For example, a recent ten-year audit at Nnamdi Azikiwe University Teaching Hospital analyzed all maternal deaths among women who delivered at the facility between 2003 and 2012, with a sample size of 8,022 live births and 103 maternal deaths.

At Delta State University Teaching Hospital, a five-year retrospective study from 2014 to 2018 reviewed 788 live births and 57 maternal deaths. Similarly, at Jos University Teaching Hospital, a study covering an unspecified period included 2,357 live births and 19 maternal deaths.

Another study at a tertiary hospital in Nigeria’s Federal Capital Territory reviewed 7,703 live births and 64 maternal deaths over five years. These studies provide valuable clinical detail and help identify direct causes—such as hypertensive disorders, haemorrhage, and sepsis—but they are inherently limited: they capture only deaths that occur within or are referred to major hospitals, and ignore the impact of private hospitals and small scale clinics in Nigeria.

The Problem of Lurking Variables: Geography, Socioeconomics, and Sample Bias
The reliance on hospital-based data introduces several “lurking variables”—hidden or unaccounted-for factors that can quietly distort the accuracy of maternal mortality statistics. These variables aren’t directly measured but still influence the outcome.

For instance, if most of the data is gathered from large public hospitals in major cities, it may overlook what’s happening in rural communities or in middle class private clinics.

In addition, if poorer women or teenage mothers—who are statistically more vulnerable—make up a larger portion of the hospital cases studied, the numbers may not reflect the broader population.

Think about it: when poverty is a widespread issue, it affects every part of life, including a mother’s access to proper nutrition, good and affordable healthcare, and timely medical attention.

While hospital inefficiency is definitely a factor, blaming Nigeria’s maternal mortality crisis solely on hospital incompetence paints an incomplete and unfair picture. The idea that hospitals alone are so dysfunctional that 1 in 19 women die during childbirth is an oversimplification. Many of these deaths may actually reflect deeper societal problems, not just failures in clinical care.

• Geography: Maternal mortality is not evenly distributed across Nigeria. The North-East and North-West zones have rates up to 10 times higher than the South-West, largely due to poverty, early marriage, and lack of access to healthcare. Rural areas, where health facilities are sparse and transport is difficult, see far higher risks than urban centers.
  

• Socioeconomic Status: Poor women—especially those with little education or living in poverty—face the greatest risk. Studies confirm that women from lower socioeconomic backgrounds are less likely to receive antenatal care or deliver with skilled attendants, directly increasing their risk of death.
  

• Sample Population: Hospital-based studies often over-represent severe cases, as many women who die in hospitals are referred in critical condition from peripheral facilities or after failed home births. For instance, in one audit, nearly 90% of maternal deaths were among “unbooked” women who had not received prior antenatal care and were referred to as emergencies. This can inflate institutional mortality ratios, making them appear much higher than national averages.

  A maternal death review in Lagos State found that nearly 90% of the deaths in both Lagos Island Maternity Hospital (LIMH) and Ajeromi General Hospital (AGH) occurred in “unbooked women,” defined as those who had not received antenatal care at the hospital and presented as emergencies with complicated labor.

  Similarly, a study from Lagos University Teaching Hospital (LUTH) showed that 87.2% of the women who died were unbooked.

• Quality of Care: Tertiary hospitals, the focus of most studies, are often overwhelmed and under-resourced. Strikes, equipment shortages, and delays in care can all contribute to higher mortality rates in these settings.
  
  

Did Researchers Account for These Biases?
Many researchers acknowledge these limitations. For example, studies at Lagos University Teaching Hospital and Jos University Teaching Hospital note that poor vital registration systems and reliance on hospital data may underestimate deaths occurring outside the health system or overstate mortality among hospital patients. Some research attempts to adjust for these biases by comparing hospital-based findings with national survey data or by using regression models to control for socioeconomic and geographic factors.

However, comprehensive community-based studies remain rare, and even the best hospital audits cannot fully capture deaths in remote rural areas or among women who never reach formal care. The result: official statistics likely understate the true scale of the crisis in some regions while overstating it in referral hospitals known for handling the most complicated cases.

The Way Forward: Beyond the Numbers
Nigeria’s maternal mortality crisis is not just a matter of health statistics—it is a reflection of deep-seated inequalities. The numbers are shaped by where a woman lives, how much she earns, her access to education, and whether she can reach a functioning health facility in time. As researchers and policymakers grapple with these challenges, the need for more robust, community-based data and targeted interventions is clear.

Conclusion
While hospital inefficiencies and systemic failures certainly play a major role in Nigeria’s high maternal mortality rates, it is overly simplistic to attribute the crisis solely to poor hospital procedures. A significant number of maternal deaths are rooted in broader, deeply entrenched lifestyle challenges—particularly poverty, low education, and geographic isolation—that disproportionately affect certain groups of Nigerian women. Women in rural communities may never access a hospital in time, and those living in poverty often cannot afford adequate antenatal care or emergency services.

Therefore, more nuanced research is needed to disaggregate maternal mortality cases into those primarily caused by healthcare system failures and those driven by social and economic barriers. Only by distinguishing between these underlying causes can policymakers design effective interventions that target both institutional reform and community-based support to save lives.