In March 2021, a fleet of three-wheeled trucks were deployed to primary healthcare facilities in Ogun State, South West Nigeria as ambulances designed to transport pregnant women and nursing mothers to the nearest hospitals.
70% of pregnant women in the region die after childbirth due to lack of necessary medical intervention, typically the result of a lack of access to both general hospitals and private healthcare facilities. “By providing reliable and swift transportation for pregnant women in emergencies, especially those in rural and under-served areas, we are ensuring that no woman has to face unnecessary delays in receiving the care she needs,” said Tomi Coker, the incumbent state commissioner for health, to local news wires.
Nigeria has a long history of maternal health crises. According to a World Health Organization report, about one in eight global maternal deaths occurs in Nigeria. A recent report from the United Nations shows a worrying trend of increasing death rates over time.
Low numbers of qualified midwives and fewer accessible means of transportation, particularly in remote and hard-to-reach places in Nigeria have resulted in lower standards of care for expectant and new mothers as well as their newborns, according to a 2020 study.
However, three years later, death rates in the state stay high while the ambulances sit largely unused due to the lack of resources needed to sustain this program. The Xylom contacted local health workers as well as state commissioner Coker to understand why, but none responded.
Residents blamed it on the government's inability to hold up to promises — another sign of the deteriorating Nigerian health sector but made worse by the unavailability of ambulance drivers, hikes in fuel prices and other logistical issues.
Kilaso Emmauel, a youth activist in Abeokuta, said he, like many others, was not even aware of this ambulance project.
“I am just getting informed. This project is supposed to have helped a lot of pregnant women who might have challenges,” he said. “In rural communities, cars don’t move at night. For this particular tricycle ambulance project, there needs to be more awareness so that it serves the rural communities it is meant to serve,” he told The Xylom.
Why are maternal deaths so common in Nigeria?
Mahmoud Abubakar Mukaram, a family medicine doctor at the Federal Medical Center in Kebbi, said that any health interventions in the country usually fail due to corruption and negligence by the Nigerian government.
“Government’s willingness to participate in health interventions is very low in Nigeria. Some of them are doing the intervention but the sustainability of it is another thing to talk about,” he said. “People who are saddled with the responsibility are very corrupt. If the government allocates some money for a project, the stakeholders will take some parts of it too.”
But these efforts can also be complicated by cultural values. Some societies in Nigeria believe that having one’s first child at home is a symbol of strength, Mukaram said.
“The first delivery will be assisted by the mother-in-law. A woman that cannot give birth at home will be labeled as not strong enough but this is harmful,” he said. “Female education and economic empowerment are very important.”
Still, Mukaram said the government should set up a committee to look into the failed intervention in Ogun State and find ways to fix it because it is a good intervention to reduce maternal mortality.
Innovative solutions need more governmental support
In the state of Niger in North-central Nigeria, about one in 95 women die due to complications with pregnancy and childbirth. However, due to efforts by nonprofit foundations, similar initiatives like those in Ogun State have shown signs of success.
Raise Foundation, a not-for-profit group aimed at providing women and children access to healthcare, has been facilitating the same initiative in remote communities since 2017 by working with health centers where ambulances have already been donated for use.
At these health centers, ambulance drivers directly pick up calls to take any expectant and nursing mothers requiring medical intervention to the nearest medical centers. They also carry kits to assist with childbirth and provide these services for free. In rural communities, the nonprofit relies on public support to provide emergency delivery responses for expectant mothers.
So far, this initiative has helped 230 women. One of them was Hauwa Kabeer, a 19-year-old resident of Bosso Local Government, who explained that she faced challenges before she had her first child in late 2022.
“There was a delay for me before we got to the hospital,” the mother of two told the Foundation. “It was a disheartening experience I would never wish to go through again.”
She said that her husband had a motorcycle that he could use to take her to the hospital for her delivery, but it broke down right before she went into labor.
Many of the women who end up using this service had previously attended an antenatal clinic session at a private healthcare clinic in their neighborhood and were given an emergency number to contact the Raise Foundation’s ambulance service.
That’s what Kabeer did for her second delivery. “I dialed the line to seek their assistance and it was timely,” she said. “They came to take me to the facility and I had a safe delivery there and they also returned me back when I was discharged.”
But due to limited funding, this initiative has failed to expand to more regions that greatly require it. An age-long issue of bandit violence also threatens this initiative, as bandits have previously been known to damage the ambulances and health centers. The tricycle ambulances are currently operating in 11 health centers in 11 different areas of Lagos, Nigeria.
But, according to Raise Foundation’s communications officer Ruth Jiya, it is not enough.
“Initially, we were having zero antenatal visits and deliveries in the centers but the numbers [of deliveries] are now going up higher,” she told The Xylom. “We are just in half of 25 local governments in the state so you can see that a [wide] margin still exists for us to cover and we can only achieve this through more funding.”
