Improving Antenatal Care and Facility Delivery Among Pregnant Women As Catalyst for Reducing Infant and Maternal Deaths in Nigeria
EHON, Idialu Anthony Ph.D.
Health Development and Public Health- Health Economics Expert
Antenatal care (ANC) remains a fundamental component of maternal health services, playing a crucial role in ensuring healthy pregnancy outcomes for both mothers and newborns. In Nigeria, maternal and infant mortality rates remain among the highest globally, largely due to inadequate access to timely and quality antenatal and delivery services. Antenatal care involves systematic medical supervision of pregnant women, including screenings, immunizations, nutritional counselling, and early detection of complications. Yet, many pregnant women in Nigeria—especially in rural areas—either do not attend ANC at all or present very late, often in the third trimester. Addressing this challenge requires expanding outreach and ensuring that ANC services are not only available but also accessible, acceptable, and affordable. A combined effort from both public and private sectors is essential to scale up coverage and improve the quality of care delivered to pregnant women across different regions of the country.
Public sector mechanisms, largely driven by government health facilities and policy frameworks, remain a central pillar in Nigeria’s maternal and child health efforts. Government hospitals, primary healthcare centers, and outreach services play critical roles in delivering ANC and facility-based delivery. The National Health Insurance Authority (NHIA), Basic Health Care Provision Fund (BHCPF), and state-level health agencies have all sought to scale maternal health services through funding, infrastructure development, and workforce training. Programs such as the National Reproductive Health Strategy have aimed to improve ANC uptake by strengthening health worker capacity, ensuring availability of essential drugs, and integrating ANC into routine community health outreach. However, persistent challenges—such as poor funding, weak infrastructure, overburdened facilities, and healthcare worker shortages—often limit the effectiveness and reach of public health services, especially in underserved communities.
On the other hand, private sector engagement in maternal health care in Nigeria has become increasingly significant, particularly in urban areas and among middle-income populations. Private hospitals, clinics, and non-profit health organizations often provide high-quality ANC and delivery services, albeit at higher costs. These facilities tend to be better equipped, and more responsive in-service delivery compared to many public counterparts. However, financial constraints limit access to private services for many low-income and rural populations. To bridge this gap, innovative public-private partnerships (PPPs) have been initiated, encouraging private facilities to provide subsidized ANC and delivery services through government support. For example, voucher programs and conditional cash transfers are being used to encourage pregnant women to use accredited private facilities for their care, thereby improving overall access and equity.
Improving facility-based delivery is another essential component in reducing maternal and infant mortality in Nigeria. Delivery in healthcare facilities—under the supervision of skilled birth attendants—significantly reduces the risk of complications such as hemorrhage, sepsis, and birth asphyxia, which are among the leading causes of maternal and neonatal deaths. Both public and private sectors must work collaboratively to increase facility delivery rates by addressing cultural, geographic, and financial barriers.
Community engagement, including sensitization programs and male partner involvement, can improve awareness and shift social norms that currently favour home births. Infrastructure improvements, such as establishing maternity waiting homes near hospitals in remote areas, can help ensure that women can access care when labour begins, thus enhancing timely and safe delivery.
One successful approach involves integrating community health workers (CHWs) and traditional birth attendants (TBAs) into formal health systems, particularly under public-private collaboration models. Training TBAs to identify danger signs and refer women to facilities for delivery can reduce delays in receiving care. CHWs, particularly in rural communities, can track pregnant women, ensure timely ANC attendance, and assist in birth preparedness planning.
Public sector support in providing medical supplies and training, coupled with private sector innovation in logistics and communication tools—such as SMS appointment reminders and telehealth consultations—can greatly enhance the reach and quality of services. These collaborative models ensure a continuum of care from pregnancy to delivery and postpartum, improving health outcomes for both mothers and newborns.
Incentivized ANC attendance and facility delivery through financial protection mechanisms can further strengthen maternal health indicators. Public-private insurance schemes, such as the NHIA-Maternal and Child Health Program, help reduce out-of-pocket expenses for pregnant women. Meanwhile, private health maintenance organizations (HMOs) can be leveraged to cover a broader spectrum of ANC and delivery services.
In states where these models have been successfully piloted, significant reductions in maternal and neonatal mortality have been reported. Scaling these approaches nationwide requires policy alignment, financial investment, and robust monitoring and evaluation frameworks to ensure accountability and quality assurance in both sectors.
Finally, data-driven decision-making and innovation are critical to sustaining maternal and infant mortality reduction efforts in Nigeria. Both the public and private sectors must invest in health information systems to track ANC attendance, delivery outcomes, and postnatal care utilization. Timely data sharing and joint performance reviews between public health departments and private providers can improve service delivery planning and identify gaps in care.
Furthermore, leveraging digital health platforms for community education, appointment scheduling, and emergency referral coordination can streamline the care continuum. Only through an integrated and inclusive approach—combining the strengths of public sector governance and private sector efficiency—can Nigeria truly achieve significant reductions in maternal and infant deaths and move closer to its universal health coverage and sustainable development goals.
