Nigeria launches free caesareans to reduce maternal deaths

Nigeria’s government started a program in 2024 that offers free emergency caesarean sections for poor and vulnerable women. The goal is to reduce the high maternal mortality rate, which is one of the highest in the world. In 2020, Nigeria accounted for nearly one-third of the 287,000 maternal deaths globally. Despite this initiative, challenges remain. Nigeria has a maternal mortality rate of 1,047 deaths per 100,000 live births. Major causes of maternal deaths include severe bleeding, infections, high blood pressure, and unsafe abortions. Most of these deaths could be prevented with timely access to emergency obstetric care. Many women delay seeking help due to costs, lack of awareness, and cultural barriers. Nigeria's healthcare system struggles with shortages of professionals and insufficient facilities. In addition, some women avoid health facilities due to the cost and the risk of being detained over unpaid bills. The initiative aims to increase the use of healthcare facilities by 60% and reduce maternal deaths by 30% in three years. To achieve this, it includes various community-centered interventions. These interventions will focus on the 17 states with the highest maternal deaths. However, there is a requirement for women to enroll in Nigeria’s national health insurance scheme to access the free caesarean sections. This presents a challenge since many poor women do not have insurance and were not part of the scheme before it became mandatory in 2022. Other African countries have successfully implemented similar initiatives without user fees, showing positive impacts on maternal and infant health. Lessons from these countries suggest that both vaginal and caesarean deliveries should be made free to ensure better outcomes. For this initiative to succeed, Nigeria will need to address the challenges in healthcare logistics, retain skilled health workers, and consider financial sustainability. The government may also need to involve the private sector more deeply and extend services to community-based health insurance programs to reach poorer families effectively.