Chinwendu Tabitha Iroegbu and Anwuli Nwankwo (Lead writers)
Aisha Abdullah, a registered midwife, had just started her morning shift at a primary healthcare centre (PHC) in Gombe State. She was checking a patient’s blood glucose level when she heard a loud voice calling out for her from the hallway. A pregnant woman had just arrived and was actively in labour.
In the face of the impending delivery, the midwife and nurses on duty sprang into action, readying themselves to support the expectant mother. The midwife engaged in a brief conversation with the woman about her health and the babies, only to discover that the soon-to-be mother had not attended a single ante-natal care (ANC) session throughout her pregnancy.
The revelation added a layer of concern to the already pressing circumstances, highlighting the urgency of providing care and safeguarding the health of both mother and child. “It wasn’t until the baby came out that we realised it was born prematurely, just around 28 to 30 weeks,” Aisha recalled. The mother unknowingly had Polyhydramnios, a condition where excess amniotic fluid causes the abdomen to appear larger than normal.
Missed ANCs and pre-term births
According to an article by the International Journal of Gynecology & Obstetrics, Nigeria ranks third in global preterm births with 774,100 preterm births. It also stated that preterm deliveries are more common among mothers who do not attend ANC which in turn are responsible for neonatal deaths in Nigeria. The World Health Organization (WHO) recommends that pregnant women attend at least eight ANC session during their pregnancy cycle to improve maternal and newborn health outcomes, but a 2024 study published by the National Library of Medicine found that only 20.3% of Nigerian women meet this standard.
That means nearly 80% of women miss critical opportunities to detect and manage high-risk pregnancies. In rural communities, barriers such as lack of transportation fees, socio-cultural beliefs, and limited awareness about the importance of ANC pose as obstacles.
According to Aisha Abdullah, many complications that lead to babies being born prematurely can be prevented with better access to regular ANC. “Even when antenatal is free, some women still don’t come because they lack awareness or support from family,” Aisha further explained.
PHCs as catalysts
In Nigeria, PHCs are designed to serve as the first point of contact for maternal and newborn care. But for many rural communities, these centres are crumbling under the weight of insufficient funding and neglect, unable to manage preterm births.
Take the Numba-Koro PHC in Niger State for instance, a level-1 facility built to offer essential services like ANC, deliveries, and immunisation. During Nigeria Health Watch’s visit, the building has deteriorated rapidly, its toilets blocked, the roofs leaking, and drug shelves sit mostly empty with only two contract staff available. Pregnant women in the community often must travel over 5 kilometres by foot to seek care elsewhere.
For mothers facing high-risk pregnancies, that delay can be the difference between life and death. ” Aisha, the midwife, shared. “If a woman is at risk of preterm delivery, we [have to] refer her immediately.”
Even well-intentioned national programmes like Group Antenatal Care (G-ANC) a free initiative aimed at improving ANC visits for pregnant women through group check-ups, health education, and peer support, are struggling to take root in many rural communities as many PHCs lack conducive environment, staff, and basic infrastructure to host these sessions.
National policy landscape
Nigeria has set up policies to strengthen its commitment to reducing newborn and maternal deaths through key policy frameworks.
One such policy is the Nigeria Health Sector Renewal Investment Initiative (NHSRII) which was launched in December 2023. It focuses on improving maternal and under-five health through investments in PHCs, infrastructure, and workforce training.
Another is the Maternal and Newborn Mortality Reduction Innovation Initiative (MAMII) which was launched in November 2024. It targets high-burden communities with strategies to reduce delays in seeking, reaching, and receiving care, enhancing access to quality emergency obstetric and newborn care (BEmONC and CEmONC).
MAMII also supports health insurance expansion, strengthens the health workforce, and institutionalises Maternal and Child Death Surveillance Review (MPCDSR). Through collaborations with local stakeholders, it aims to address key drivers of maternal and newborn mortality — particularly benefiting preterm infants.
However, Despite the stated policy objectives, several shortcomings contribute to the persistent burden of preterm births:
- Inadequate Implementation at Subnational Levels: This leads to fragmented implementation, hindering a unified national response to preterm birth prevention and management. Without strong subnational ownership and capacity, even well-designed national policies remain largely on paper.
- Persistent Funding Gaps for Specific Interventions: While overall health budgets have seen increases, a lack of dedicated and sufficient investment plans for specific elements remains a concern. For instance, despite the cost-effectiveness of interventions like Kangaroo Mother Care (KMC), and the need for basic equipment like, continuous positive airway pressure (CPAP) machines, facilities often lack these resources.
- Critical Human Resources for Health Deficits: The “brain drain” continues to deplete Nigeria of its skilled healthcare professionals, and those remaining are often maldistributed, overstretched, and under-motivated. This shortage directly impacts the quality of care for preterm babies, as specialized knowledge, and continuous availability of skilled staff are crucial for their survival.
- Inadequate Data Collection and Utilisation: Despite policies emphasizing data-driven decision-making, data collection and monitoring for maternal and newborn health, including specific indicators for preterm births, remain weak and inconsistent.
From statistics to action: the looming crisis of preterm births in Nigeria demands a comprehensive and coordinated response from stakeholders across multiple sectors. Addressing this crisis requires dedicated funding for targeted interventions, such as those targeted at preterm births, the adoption of of performance-based financing models for states, and the establishment of robust monitoring and accountability mechanisms.
In addition, there is a need to standardise and implement evidence-based clinical protocols, conduct regular case review and mortality audits, and prioritise the local production of essential medical commodities such as antenatal corticosteroids and magnesium sulphate, which have been proven to significantly reduce preterm births and associated complications.
By integrating these strategies into existing health policies, Nigeria can shift from a reactive approach to a proactive, preventive model for managing preterm births — ultimately improving outcomes, saving lives, and building a more resilient and equitable healthcare system for its youngest population.