MAMII: A Promising Initiative to Crash Maternal Mortality in Nigeria
Onyedikachi Ewe (Lead Writer)
“Health is on the front burner”, and the current administration has set the goal “to crash maternal mortality”. This objective has become a key focus in Nigeria’s health leadership, driving initiatives aimed at addressing and decreasing maternal mortality.
The launch of the Maternal and Neonatal Mortality Reduction Innovation and Initiatives (MAMII) during the Joint Annual Review (JAR) in November 2024 demonstrated the priority of the Sector Wide Approach (SWAp) to reduce maternal mortality,targeting 172 Local Government Areas (LGAs) across 33 Nigerian states. Although these LGAs make up only 20% of the total number of LGAs in Nigeria, they account for up to 55% of Nigeria’s maternal mortality rate (MMR). This disparity highlights the urgent need for maternal health intervention in these areas.
Maternal mortality in Nigeria
Despite decades of investments in maternal health care, Nigeria’s MMR has remained high, with about one death in every 200 live births due to pregnancy-related complications.
Although these deaths are largely preventable, women continue to face unnecessary risks due to a combination of factors such as — inadequate healthcare infrastructure, limited access to skilled care, socio-cultural barriers, and insufficient health financing.
There is also a disproportionate number of these deaths occurring in rural areas, where there is poor access to healthcare, and socio-cultural beliefs and practices delay timely medical interventions. These challenges compound the vulnerability of women, particularly those located in low-income settings, who often face the greatest barriers to receiving quality maternal care.
Various interventions have been introduced over the years to improve maternal health outcomes. However, the unrelenting high MMR is a stark reflection of the systemic challenges in Nigeria, which continue to hinder progress, and reminds us of the urgent need for sustained efforts to address these gaps at both the policy and community levels.
One size doesn’t fit all
The design for MAMII involves conducting a deep dive to understand the specific drivers of maternal deaths in communities and designing context-specific solutions and coordinated interventions to address the identified challenges.
MAMII’s strategic framework is summed up in six pillars that seek to address the three delays contributing to maternal mortality.
These pillars include community programming and innovation, which involve boosting health literacy, deploying health workers in the community, and strengthening continuity of care through effective referrals and follow-ups. Access to intervention is another pillar, which involves increasing geographic and financial access through state health insurance. Health facility programming and innovation ensure that facilities are equipped to handle complications during pregnancy, delivery, and post-delivery, thereby reducing maternal deaths.
Data, leadership and governance will focus on maternal, perinatal and child death surveillance and response (MPCDSR) to use findings from maternal death reviews for quality improvement.
Key enablers for reducing maternal mortality, such as the use of digital health solutions, strategic communications and integral component of the strategic framework that will be implemented to enhance health system performance.
Lastly, MAMII will align institutions and resources with the SWAp principle of “one plan, one budget, one conversation and one voice”.
How MAMII is different
Initiatives like the Midwife Service Scheme which focused on improving human resource for health by recruiting midwives to provide maternal health care in rural areas, as well as Saving One Million Lives Program for Result, a performance-based funding to states to improve maternal and child health, have been implemented in the past to address maternal mortality in Nigeria. MAMII, however, brings a unique approach by aligning and fostering collaboration, and ensuring a more unified strategy to tackle the root causes of maternal deaths across the selected LGAs.
Following the official launch, stakeholders convened for five days in Kano State in January 2025 to develop implementation strategies. Kano State accounts for the highest MMR in Nigeria, with 18 of its 44 LGAs included in the MAMII intervention plan. Field visits to 10 LGAs provided a deep dive into the key causes of maternal and neonatal deaths in communities.
The field visit provided insights for crafting a tailored, context-specific implementation plan across MAMII’s strategic pillars. This included but was not limited to increasing emergency transport and improving referral linkage especially from facilities that provide Basic Emergency Obstetric and Newborn Care (BEmONC) to facilities where patients can access Comprehensive Emergency Obstetric and Newborn Care (CEmONC) including free caesarean sections depending on the course and history of the pregnancy.
MAMII will also improve the number and capacity of healthcare workers, improve access to health insurance, institutionalise community MPCDSR, and provide a wide range of life saving interventions.
This implementation plan was designed collaboratively with stakeholders, including representatives from Federal and State Ministries of Health, LGAs and community representatives, the World Bank, UNICEF, UNFPA, Society for Family Health and Nigeria Health Watch.
The plan, which was presented to the state for adoption, will guide the rollout of MAMII in Kano State. The implementation workshop will be replicated in other MAMII focus states to address all 172 LGAs with context-specific interventions and solutions.
Towards crashing maternal mortality in Nigeria
Addressing maternal mortality in Nigeria requires a multi-faceted approach which goes beyond healthcare interventions. The major drivers of success in other countries that have made significant progress in reducing maternal mortality — like Bangladesh and India and African countries like Ethiopia and Senegal, Exemplars for country success — were achieved through a holistic approach. This included increased access to contraceptives through educating women, having women participate in the labour force, political prioritisation of maternal and neonatal health, improved quality of care and increased contact with maternity services.
The conversation about “crashing maternal mortality” cannot be separated from addressing the broader social determinants of health. Key factors such as education (especially girl-child education), access to basic amenities like electricity, clean water, sanitation and hygiene (WASH), and access to family planning services must be part of the interventions adopted.
With the launch and full implementation of MAMII, which adopts a holistic approach to addressing maternal health challenges in Nigeria, and by integrating various interventions and relevant sectors into its design, while learning from global successes, we can hope for a future where no woman has to die while giving birth.
