The suspension of the Safe Termination of Pregnancy (STOP) guideline in Nigeria, especially in Lagos, has had consequences that go beyond policy. It has created uncertainty inside health facilities and left many health workers unsure about what they are allowed to do. This uncertainty fuels fear, and fear quietly seeps into patient care.

Without clear legal backing or institutional protection, some health workers become overly cautious. During our encounter with healthcare workers at a recent workshop, several openly mentioned that they fear losing their jobs, which is why they avoid carrying out safe termination of pregnancy services in their facilities. In maternity wards, where every minute can decide life or death, hesitation can be deadly.

Stigma inside healthcare facilities doesn’t always shout. It shows up as delays, reluctance to act, or judgment disguised as caution. A provider who pauses before intervening. A nurse who waits for approval before giving urgent care. These may seem small, but in emergencies, every second counts.

For many women in Lagos seeking maternal health care, stigma and fear from health workers shape their experience. Some are questioned or judged for their age, marital status, or pregnancy history before being treated. Others are ignored or spoken to without compassion at critical moments. These interactions discourage women from coming back, even when they need timely care.

This problem is not rooted in individual cruelty. Most health workers are competent and committed. The issue stems from unclear laws, suspended guidelines, and a lack of government support. When policies are contradictory or absent, providers are left to guess, and that guesswork directly affects the quality of care.
To reduce maternal deaths, it is not enough to train health workers. They need clear, protective policies and legal reassurance that allows them to act swiftly and confidently. When health workers feel safe to provide evidence-based care without fear, women’s lives are more likely to be saved.

Understanding Stigma in Maternal Healthcare

In healthcare, stigma refers to attitudes and behaviors that undermine a patient’s dignity, autonomy, and right to respectful treatment. In maternal services, Social expectations surrounding women’s reproductive choices often link to it. Poverty, low education, disability, adolescent pregnancy, or experiences of gender-based violence may further expose women to judgment or neglect.
When these attitudes become normalized, women may withhold important health information, delay clinic visits, or avoid facilities entirely. Trust between patients and providers weakens, and opportunities to detect complications early are lost.

A Continuum of Harm:

Stigma can affect women throughout pregnancy and after childbirth. During antenatal visits, some women may hide symptoms or previous complications out of fear of judgment. Delayed attention or dismissive responses can allow manageable conditions to become life-threatening. After delivery, stigma may also limit access to postnatal care, breastfeeding support, family planning counselling, and follow-up services.
These patterns are not always intentional. Many health workers operate under heavy workloads, staff shortages, and limited psychosocial training. Without institutional support and accountability, harsh communication styles can become routine rather than recognized as harmful.

The Deadly Cost of Silence and Fear

According to the Nigeria Demographic and Health Survey (NDHS), Nigeria continues to record one of the highest maternal mortality ratios globally. Current estimates indicate about 512 maternal deaths per 100,000 live births, and many of these deaths are preventable with timely and skilled care.
When women anticipate humiliation or neglect, they may delay seeking help, attempt home delivery without skilled assistance, or rely on untrained providers. Fear often shapes these actions as coping strategies, although people sometimes describe them as poor health-seeking behavior. Delayed care increases the likelihood of severe complications such as hemorrhage, infection, hypertensive disorders, and obstructed labour, which are major causes of maternal deaths.

Why Stigma Persists in Healthcare Settings

Several factors allow stigma to persist. Chronic staff shortages, heavy workloads, and limited training in communication or psychosocial support reduce providers’ empathy and patience. Cultural beliefs and gender norms reinforce judgment toward women’s reproductive choices, while weak reporting and accountability systems rarely address mistreatment.
Without deliberate corrective measures, these behaviors can become normalized within everyday clinical practice.

Respectful Maternity Care: A Lifesaving Approach

Respectful maternity care is not an optional courtesy; it is a fundamental component of quality health care. It emphasizes dignity, informed consent, privacy, empathy, and non-discrimination throughout pregnancy and childbirth.
In some public health facilities in Lagos State, capacity-building efforts are increasingly focusing on communication skills, patient rights, and ethical responsibilities alongside clinical competence. Health workers report that improved communication encourages women to share concerns earlier and seek care more consistently.

From Policy to Practice: What Must Change

Reducing maternal deaths requires more than medical equipment and infrastructure. Healthcare institutions should prioritize continuous training on respectful, rights-based care for healthcare workers. Health facilities also establish clear policies that prohibit mistreatment and strengthen accessible mechanisms for feedback to improve accountability.
Communities also play a role by supporting women’s health decisions and encouraging early, consistent use of appropriate care.

Conclusion: Dignity as a Pathway to Survival

Medical complications do not cause maternal deaths alone. Systems that fail to provide respectful and compassionate care also contribute to maternal deaths. Addressing stigma within maternal health services is therefore both an ethical and public health priority.
No woman should fear the place meant to save her life. From antenatal clinics to the labour ward, empathy, dignity, and respect must become the standard of care rather than the exception.