Determinants and differentials of Maternal Reproductive Health Outcomes in Nigeria: A Review of National Demographic Health Survey Data from 1999 to 2013

Introduction: Around 1500 women in Nigeria die every day from problems related to pregnancy and childbirth. Many more experience life-threatening complications during pregnancy and delivery that endanger both the pregnant women and the unborn child often resulting in severe disabilities.  These women die from preventable causes related to endemic poverty, entrenched socio-cultural and religious inhibitions, and poor health sector funding.

Objective: To determine the trends and differentials in maternal morbidity and mortality indices in Nigeria.

Methods: The study is a review and trend analysis of the 1990 and 2013 National Demographic and Health Survey (DHS) data as well as a review of secondary data from WHO, UNICEF and the World Bank. 

Results: The total fertility rate (TFR) is currently 5.34 births per woman.  The prevalence of contraception however has remained very low especially among those with primary or no education. Adolescent fertility rate has declined from 178 to 121 live births /1000 in women aged 15-19 years. Deliveries attended by skilled health providers witnessed a marginal increase from 30.8% to 39%; 60% of deliveries are not attended by skilled health providers. MMR declined from 880 /100.000 live births in 1990 to 545/100,000 in 2008. There is however high level of anaemia in pregnancy and childhood malnutrition. Total health expenditure (THE) as a percentage of GDP increased from 4.6% in 2000 to 6.6% in 2007, however Private expenditure on health (PEH) as % of THE increased from 66.5% in 2000  to 74.7% in 2007 with out of pocket expenses accounting for 96.9% of the PEH.

Conclusions: A paradigm shift is advocated (with women as the driving force) to address fundamental contemporary inimical religious, ethno-cultural and socio-economic factors if Nigeria is to succeed in addressing her poor maternal reproductive health challenges.