The World Health Organization (WHO) says the high number of maternal deaths in some parts of the world reflects inequities in access to health services, and highlights the gap between rich and poor. Nearly 100% of global maternal deaths occur in developing countries with more than half of these deaths occurring in sub-Saharan Africa and almost one third happening in South Asia. More than half of maternal deaths occur in fragile and humanitarian settings. 

WHO adds that poor women in remote areas are the least likely to receive adequate health care. This is especially true for regions with low numbers of skilled health workers, such as sub-Saharan Africa and South Asia. Globally in 2015, births in the richest 20 per cent of households were more than twice as likely to be attended by skilled health personnel as those in the poorest 20 per cent of households (89 per cent versus 43 per cent). This means that millions of births are not assisted by a midwife, a doctor or a trained nurse.

The 7 papers included in the BJOG supplement shed light on some aspects of the Nigerian maternity care and health system, particularly at the tertiary level, between 2012 and 2013. They are offshoots of a landmark survey – Nigeria Near-Miss and Maternal Death Survey – which recorded close to 1000 maternal deaths in 42 tertiary hospitals spread across Nigeria. When getting there is not enough: a nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country

The supplement helps readers understand the reasons for the high intra-hospital deaths associated with pregnancy-related complications. Among the issues discussed in-depth include hypertensive disorders of pregnancy, postpartum hemorrhage, and unsafe abortion. An in-depth analysis of uterine rupture—a major sign of delays in managing obstructed labor–is also featured.

The Nigeria Near-Miss and Maternal Death Survey revealed that intra-hospital quality of care issues, and delays in accessing the adequate level of care play a major part in the occurrence of maternal deaths. Moreover, maternity care and the underlying health system experience challenges in reducing avoidable deaths and promoting health and well-being.