Maternal mortality has remained a topical issue, even though maternal mortality ratio dropped by 38% globally from 2000-2017[i]. Most high-income countries have low maternal death rates that have consistently decreased in the last two decades, with the exception of the United States that has shown a 16.7% increase since 1990[ii].

Furthermore, significant racial/ethnic disparities in pregnancy-related mortality exist in the US, with black women having a pregnancy-related mortality ratio approximately three times higher than that of white women[iii]. It is therefore no wonder that the US marks the National Minority Health month every April, and the week of April 11-17, 2020 has been set aside to amplify the conversations about black maternal health. 

The WHO reports that 94% of all maternal deaths happen in low- and middle-income countries[iv]; and in 2017, Nigeria accounted for 66,000 of the 196,000 maternal deaths that occurred in Sub-Saharan Africav.

In a bid to improve maternal (and newborn) health care delivery and outcomes in Nigeria, Health Strategy and Delivery Foundation (HSDF), in partnership with the Private Sector Health Alliance of Nigeria (PSHAN) and Bill and Melinda Gates Foundation in 2014, commenced implementation of the Nigeria Healthcare Quality Initiative (NHQI) in three Nigerian states.

The prototype phase (November 2014 – September 2017) was associated with a baseline reduction in facility-based maternal deaths of 25%, 34% and 37% respectively in Lagos, Imo and Niger States after 18 – 27 months of implementation. This phase demonstrated that a focus on quality improvement (QI) capability building, rapid data testing, implementing change ideas, feedback and learning can significantly improve facility-based maternal (and neonatal) mortality.

HSDF continues to engage substantively with healthcare leadership and frontline workers using data from our on-going work (November 2017 – date) to highlight (contextual) systemic gaps and address intervention priorities. Facilities in the collaboratives have shown consistent improvement in maternal care processes, meeting and even surpassing project targets.

Facilitator demonstrating the steps for breech extraction during the Comprehensive Basic Life Saving Skills Obstetrics training for healthcare workers

As the global thrust towards attaining the Sustainable Development Goal 3 gains momentum, health systems would need to prioritize strategies which deliver quality maternal care that is accessible, if we intend to leave no woman behind.


[i] https://www.who.int/en/news-room/fact-sheets/detail/maternal-mortality

[ii] WHO, UNICEF, UNFPA, et al. Trends in maternal mortality: 1990 to 2010. Geneva, Switzerland, 2012

[iii] CDC. Pregnancy Mortality Surveillance System. Atlanta, GA: US
Department of Health and Human Services, CDC; 2019. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-system.htm

[iv] https://www.who.int/news-room/fact-sheets/detail/maternal-mortality

V http://documents.worldbank.org/curated/en/793971568908763231/pdf/Trends-in-maternal-mortality-2000-to-2017-Estimates-by-WHO-UNICEF-UNFPA-World-Bank-Group-and-the-United-Nations-Population-Division.pdf