By Collins Odigie Ojiehanor
In many rural communities across Nigeria, pregnancy is not only a journey toward motherhood; it is often a journey filled with uncertainty, risk, and difficult choices. While cities continue to expand access to modern healthcare, countless rural women still face overwhelming barriers when trying to access basic maternal care.
Behind every statistic about maternal mortality is a real story, a mother who walked miles for antenatal care, a family searching desperately for transportation during an emergency, or a health worker struggling to provide care with limited resources.
A 2023 report by the World Health Organization highlighted the severity of the global maternal health crisis, revealing that a woman dies from pregnancy-related complications every two minutes. The situation is particularly severe in Sub-Saharan Africa, which accounted for about 70 percent of global maternal deaths in 2020. Within the region, Nigeria remains one of the most affected countries.
According to estimates by the World Health Organization, Nigeria’s maternal mortality ratio (MMR) stands at 1,047 deaths per 100,000 live births, placing it among the countries with the highest maternal mortality rates globally. The report ranked Nigeria third, behind South Sudan with 1,223 deaths per 100,000 live births and Chad with 1,063.
Further underscoring the scale of the challenge, Nigeria’s Coordinating Minister of Health and Social Welfare, Muhammad Ali Pate, stated during the 2024 celebration of National Safe Motherhood Day that approximately 57,000 Nigerian women died in 2023 from complications related to pregnancy and childbirth.
Maternal Health Realities
One of the most striking realities of rural healthcare in Nigeria is the distance between communities and functional health facilities. In many villages, the nearest clinic may be several kilometers away.
For pregnant women, especially in their final trimester, this distance can be both exhausting and dangerous. Poor road networks, lack of transportation, and the cost of travel often make accessing care extremely difficult.
During one of my field visits, I encountered women who had travelled for hours, some alone, others accompanied by their husbands or relatives on motorcycles to reach the Primary Health Centre in Olinlin community, Uzea, in Esan North-East Local Government Area, Edo State, Nigeria, for antenatal care and delivery.
For many of them, this difficult journey was the only way to access basic maternal healthcare services. Unfortunately, situations like these are not isolated incidents. They reflect a broader pattern that continues to define maternal healthcare in many rural communities across Nigeria, where distance, poor transportation, and limited health facilities remain significant barriers to safe motherhood.
Fifty-five-year-old Esther, a mother of four, recalled that she delivered all her children at the Olinlin Primary Health Centre. She explained that during her pregnancies, she and other women often walked several kilometres from their community, Amah, to the health facility for antenatal care.
According to her, transportation becomes particularly difficult during labour, as motorcycles are not always available to take pregnant women to the hospital. As a result, some women are forced to give birth at home.
Without ambulances or reliable transport systems, families are left to arrange their own means of travel. For many rural households already struggling with poverty, this can delay critical care.
These conditions have also contributed to the continued reliance on traditional birth attendants (TBAs) in many rural communities. According to Esther, traditional birth attendants are often trusted figures who live within the community and are accessible to pregnant women at all times.
While they play an important role in local support systems, many TBAs lack the medical training and equipment necessary to manage complications during childbirth. As a result, when emergencies occur, it may already be too late by the time a woman is taken to a hospital.
This reality continues to contribute to Nigerias high maternal mortality rate, particularly in rural areas. Although progress has been made in recent years, the country still accounts for a significant share of global maternal deaths, with many of these cases occurring in underserved communities where access to skilled birth attendants remains limited.
Healthcare workers in rural facilities also face enormous challenges. Many rural health centres operate with only one to three staff members responsible for attending to patients daily. This shortage places immense pressure on the few available health workers, who must often perform multiple roles at once.
A single nurse or midwife may be responsible for antenatal care, childbirth, immunizations, and general outpatient services. Under such circumstances, providing comprehensive and timely care becomes extremely difficult.
Some facilities operate without stable electricity, clean water, or essential medical supplies. In emergency situations, these gaps can make the difference between life and death. Beyond infrastructure, social and economic factors also influence maternal health outcomes in rural communities.
Many families depend on subsistence farming or small-scale trading, and the cost of healthcare can be a significant burden. Even when services are subsidized, the cost of transportation, medication, and other associated expenses may discourage families from seeking timely care.
Gender dynamics also play a role. In some cases, women may need permission from their husbands or family members before seeking medical care, which can lead to delays during pregnancy-related emergencies.
The Hope for Maternal Health
Despite these challenges, rural communities continue to demonstrate remarkable resilience. Pregnant women make extraordinary efforts to attend antenatal visits whenever possible, and healthcare workers remain committed to serving communities despite limited resources.
However, resilience alone cannot solve systemic problems. Improving maternal healthcare in rural Nigeria will require a combination of policy commitment, sustained investment in primary healthcare, and stronger community engagement.
Expanding the number of trained health workers in rural areas, improving transportation infrastructure, equipping primary health centres, and strengthening referral systems are all essential steps.
Government programs aimed at strengthening primary healthcare must also prioritize rural communities where the need is greatest. When health facilities are properly staffed and equipped, pregnant women are more likely to seek care and deliver in safe environments.
Equally important is ensuring that rural women feel confident and supported in accessing healthcare services. Community outreach programs, maternal education initiatives, and partnerships with traditional birth attendants can help bridge the gap between communities and formal healthcare systems.
The road to safe motherhood in rural Nigeria should not be defined by distance, scarcity, or uncertainty. Every woman, regardless of where she lives, deserves access to quality maternal care and the opportunity to give birth safely.
Ensuring safe motherhood should not depend on geography. Until rural communities receive the attention and investment they deserve, the long road to care will remain a defining reality for many Nigerian women.
Also Read: Type 5 Diabetes: How Malnutrition Is Fueling a Hidden Health Crisis in Vulnerable Communities
Between Hills and Hope: Rethinking Rural Sexual and Reproductive Health in Rwanda
Collins Odigie Ojiehanor is a Nigerian journalist with Diamond Media, specialising in public health, environmental reporting, and social development. His work focuses on documenting the lived experiences of communities, particularly in areas related to healthcare, environmental challenges, and social inequality. Through his reporting, he seeks to amplify marginalised voices and contribute to conversations that promote accountability, policy attention, and sustainable development.
Profile: https://www.linkedin.com/in/collinsojiehanor
Portfolio: https://bit.ly/Collins_Portfolio
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