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In Nigeria maternal mortality is estimated to be 1000/100000 births and rising. Nigeria is one of the 29 countries in sub-Saharan Africa that are among the 47 poorest countries in the world. Since 1950 the gulf between the richest and poorest countries in the world has increased from 8-fold to 30-fold. The impact of Nigerias poverty on maternal mortality can be seen by the fact that for Nigeria a 400-fold increase in maternal death accompanies a 66-fold disadvantage in gross national produce per capita as compared to Singapore (the countries were comparable in the 1960s). Most hospital maternal deaths in Nigeria occur after emergency hospitalization of women who received no prenatal care and/or were neglected in labor and during the postpartum period. Most of these women suffer simultaneous morbidities which increase risk to themselves and their babies. Structural adjustment programs have contributed to the decline in maternal health by instituting policies that promote inequities fail to control debt and lead to declining school enrollments and dismantling of social welfare programs. High user fees have discouraged at-risk women from seeking care and the number of women at risk is increased by early marriage low contraceptive prevalence high fertility and unsafe illegal abortions. Examples exist of poor countries where maternal mortality has been reduced drastically by widespread literacy and contraceptive usage and equity in health care. Nigeria has the capacity of achieving equally good results by establishing proper referral systems and exempting pregnant women from user fees. What is required is determined leadership and a focus on emergency obstetric treatment as well as efforts to reduce the occurrence of such emergencies.
K. A. Harrison (Sat,) studied this question.