Why Nigerian women are still dying in childbirth — Experts

Nigeria continues to grapple with an alarming maternal mortality crisis, a complex issue rooted in systemic failures across healthcare provision, access, and the persistence of harmful cultural practices. This article examines the legal and regulatory landscape intended to safeguard maternal health in Nigeria, highlighting significant gaps between robust statutory frameworks and their practical implementation. Despite constitutional provisions, ratified international treaties, and national health legislation, thousands of women still die during childbirth due to poor quality care, delayed hospital access, and entrenched traditional beliefs. The analysis delves into the enforceability of medical negligence claims, the limitations of health rights, and the challenges in eradicating harmful practices, underscoring the urgent need for comprehensive legal reform and improved accountability.

Nigeria faces a profound public health and human rights crisis as thousands of women continue to die during childbirth, a stark reality that healthcare experts attribute to a confluence of poor care, delayed hospital access, and deeply ingrained harmful cultural beliefs. This tragic phenomenon not only signifies a failure in public health but also represents a significant breach of fundamental human rights, particularly the right to life and health, for Nigerian women. Despite being Africa's most populous nation and a signatory to various international and regional human rights instruments, Nigeria consistently records one of the highest maternal mortality rates globally.

This article critically examines the legal and regulatory frameworks designed to protect maternal health in Nigeria, assessing their efficacy in addressing the identified drivers of maternal mortality. It argues that while Nigeria possesses a foundational legal architecture, including constitutional provisions, national health acts, and international obligations, the persistent crisis is largely due to inadequate implementation, enforcement deficits, and the non-justiciable nature of certain rights. By dissecting the legal implications of poor healthcare quality, barriers to timely medical intervention, and the legal challenges in confronting harmful traditional practices, this analysis aims to illuminate pathways for legal professionals to advocate for and contribute to a future where safe childbirth is a guaranteed right for all Nigerian women.

The legal foundation for health rights in Nigeria is multi-layered, drawing from both domestic and international instruments. Domestically, while the 1999 Constitution of the Federal Republic of Nigeria (as amended) does not explicitly enshrine a justiciable right to health, Section 17(3)(d) directs the State to ensure that "medical and health facilities for all persons are provided." However, this provision falls under Chapter II, the Fundamental Objectives and Directive Principles of State Policy, which are generally non-justiciable. Nonetheless, other fundamental rights, such as the right to life (Section 33) and the right to dignity of the human person (Section 34), have been invoked in attempts to secure health-related protections.

Internationally, Nigeria has ratified key human rights treaties that impose obligations regarding maternal health. These include the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and the Protocol to the African Charter on Human and Peoples' Rights on the Rights of Women in Africa, commonly known as the Maputo Protocol. Article 14 of the Maputo Protocol is particularly significant, mandating States Parties to ensure the right to health for women, including sexual and reproductive health, and to provide comprehensive healthcare services, including antenatal, delivery, and postnatal care. Furthermore, the National Health Act 2014 provides a framework for regulating, developing, and managing a national health system, aiming to protect, promote, and fulfill the rights of Nigerians to access healthcare services, including a basic minimum package of health services. The National Reproductive Health Policy (2010) and the National Health Insurance Authority Act 2021 further articulate governmental commitments to improving maternal health outcomes and expanding health insurance coverage, particularly for vulnerable groups like pregnant women.

The persistent high rates of maternal mortality in Nigeria reveal critical gaps in the enforcement and scope of existing legal and policy frameworks. One primary factor is the issue of poor care, often manifesting as medical negligence. Under Nigerian law, medical negligence follows the 'Bolam principle,' requiring proof that a medical professional's conduct fell below the standard accepted as proper by a responsible body of medical professionals in that specialty, directly causing harm to the patient. While the National Health Act 2014 mandates quality healthcare and patient rights, including the right to complain and seek remedy for substandard care, pursuing such claims remains challenging due to high legal costs, systemic barriers, and a perceived 'conspiracy of silence' among medical professionals. Recent cases, such as the tragic death of Mrs. Akudo John following childbirth complications, underscore allegations of delayed intervention and poor clinical judgment, highlighting the practical difficulties in securing accountability.

Delayed arrival at hospitals and limited access to healthcare facilities, particularly in rural areas, constitute another significant legal and policy failure. Although the National Health Act 2014 aims to ensure a basic minimum package of health services for all Nigerians, and the National Health Insurance Authority Act 2021 established a Vulnerable Group Fund to subsidize care for pregnant women, implementation remains a hurdle. The National Primary Health Care Development Agency (NPHCDA) was established to strengthen primary healthcare infrastructure and ensure essential services, including maternal and child health, are accessible. However, geographical disparities, inadequate infrastructure, and financial barriers continue to impede timely access to skilled birth attendants and emergency obstetric care, leading to preventable deaths. The *SERAP v Attorney-General Lagos State* (2020) case, where a policy requiring blood donation from relatives as a condition for maternal care was declared a human rights breach, illustrates how administrative policies can unlawfully obstruct access to essential services.

Harmful cultural beliefs and traditional practices further exacerbate the crisis, often trapping women in cycles of poor health outcomes. Practices such as female genital mutilation (FGM), son preference leading to neglect of female health, gishiri cut, and forced home deliveries are deeply rooted in many Nigerian communities. While the Violence Against Persons (Prohibition) Act, 2015 (VAPP Act) criminalizes FGM and other harmful traditional practices, its enforcement is inconsistent, and many states have yet to fully adopt and implement it. The challenge lies not only in legislation but also in changing entrenched societal norms and ensuring that legal protections translate into behavioral change at the community level.

Moreover, the non-justiciability of socio-economic rights in the Nigerian Constitution presents a fundamental contradiction, limiting the ability of citizens to directly enforce their right to health through the courts. While international instruments like the Maputo Protocol are ratified, their direct enforceability in Nigerian courts often requires domestication into national law, a process that is frequently slow or incomplete. The ECOWAS Court of Justice's decision in *Dorothy v. Federal Republic of Nigeria* (2025), which reaffirmed Nigeria's obligations under the Maputo Protocol to provide access to safe abortion in specific circumstances (rape, sexual assault, incest, or threat to health), signals a potential avenue for regional human rights litigation to influence domestic policy, despite the petitioner's specific claim not being fully proven. This highlights the ongoing struggle to bridge the gap between international commitments and national legal realities.

Finally, access to justice for victims of maternal mortality is severely hampered. While institutions like the Legal Aid Council exist, their resources are often inadequate, and many vulnerable Nigerians remain unaware of their rights or the legal avenues available for redress. The *WARDC & Another v Attorney General-Nigeria* (2015) case, concerning the illegal detention and subsequent death of a woman for unpaid hospital bills, underscores the vulnerability of women to human rights abuses within the healthcare system and the critical need for effective legal recourse. The confluence of these legal and practical challenges perpetuates the maternal mortality crisis, demanding a more robust and integrated approach to legal enforcement and human rights protection.

The persistent tragedy of maternal deaths in Nigeria is a stark indicator of the systemic failures in upholding the fundamental human rights of women. While Nigeria has established a legal and policy framework, including constitutional directives, international treaty obligations under CEDAW and the Maputo Protocol, and national legislation like the National Health Act 2014 and the VAPP Act 2015, the chasm between these provisions and their effective implementation remains vast. The non-justiciability of core health rights, coupled with inadequate enforcement mechanisms for medical negligence, barriers to healthcare access, and the enduring influence of harmful cultural practices, collectively undermine efforts to safeguard maternal health.

For legal practitioners, the crisis presents a compelling call to action. There is an urgent need to advocate for the domestication and rigorous enforcement of international human rights instruments, particularly the Maputo Protocol, and to push for the justiciability of health rights within the Nigerian Constitution. Lawyers must continue to pursue medical negligence claims to hold healthcare providers accountable, while also engaging in public interest litigation to challenge discriminatory policies and practices that impede access to care. Furthermore, legal aid services must be strengthened and expanded to ensure that indigent women can access justice when their rights are violated. By actively engaging in legal reform, strategic litigation, and public advocacy, the legal community can play a pivotal role in transforming the legal landscape to ensure that every Nigerian woman has the right to a safe and dignified childbirth, free from preventable death and suffering.