Nigeria cannot talk seriously about child survival without looking closely at maternal health. Healthy pregnancies and safe deliveries are essential, but they are only the beginning. What happens to mothers and their children in the months and years after birth often determines whether a child reaches their fifth birthday.

In Nigeria, this is a life‑and‑death issue. Recent national data show that around 110 out of every 1,000 children still die before age five, that is, roughly one in nine Nigerian children. That is one of the heaviest under‑five burdens in the world, and it sits alongside a maternal mortality ratio that remains among the highest globally. Women and their children are being lost along the same fragile continuum of care, and treating these as separate problems hides how deeply they are connected.

Clinicians see this linkage every day. Obstetrician and gynaecologist Dr Zeenaht Abdullahi puts it plainly: “In my experience, maternal health outcomes and survival of children in their early years are interwoven, where one significantly influences the other. Mothers who are healthy during pregnancy and in the post-partum are able to provide hands-on care to their infant: ensuring the child has optimal nutrition by exclusively breastfeeding, cord care to prevent infection, and early detection of markers that might be indicative of a physical or neurodevelopmental anomalies. Healthier mothers have the physical and mental well being capacity to prevent, detect and subsequently seek care for children.”

Her perspective reflects what the data also show: when mothers are unwell, unsupported or constantly battling structural barriers, their children face higher risks of illness and death.

Yet once a “safe delivery” has been recorded, the system often looks away. Families leave facilities that may have worked hard to ensure a live birth and return to communities where the environment is far less protective. Some mothers go back to neighbourhoods where they can easily complete their child’s immunisation schedule, access clean water and get quick treatment for common childhood illnesses. Others return to settlements where the nearest clinic is distant, health workers are overstretched, stock‑outs are frequent and preventable killers like diarrhoea, pneumonia and malaria are constant threats. On paper, both women are counted as maternal health success stories. Months later, only one child may still be alive. That quiet divergence is rarely captured in statistics, but it is where many Nigerian families actually live.

This is why supporting mothers remain central to any serious child survival agenda. During pregnancy, women attend antenatal appointments, listen to medical advice and make decisions that shape birth outcomes. After delivery, they are the ones who ensure children receive vaccines, seek help when fevers and coughs begin, and decide whether a child with diarrhoea is taken swiftly to a facility or treated at home. Even the most dedicated mother, however, cannot fully protect her children from challenges that are structural: a broken primary health care system, the absence of basic water and sanitation, the costs and distance involved in seeking care. Blaming individual caregivers for outcomes that reflect systemic neglect is both unfair and unproductive.

The good news is that we already know many of the solutions. Global and national analyses consistently show that simple, preventive interventions like exclusive breastfeeding, full immunisation, vitamin A supplementation, insecticide‑treated bed nets, good nutrition and prompt treatment of malaria, diarrhoea and pneumonia could avert the majority of deaths in children under five if they were delivered reliably to the children who need them. In high‑mortality settings like Nigeria, modelling suggests that scaling up these proven child survival interventions could prevent hundreds of thousands of deaths every year. But none of this is automatic. It depends on whether mothers are supported to access these services, to trust the health system, and to return to it repeatedly during the first five years of their children’s lives.

Seeing maternal health and child survival as one continuum helps to clarify the task. Antenatal care, safe delivery, post‑natal visits, immunisation, nutrition counselling and community‑based prevention should not be competing programmes, each fighting for limited attention and funding. They should be understood as linked investments in the same mother and the same child. When a woman meets a midwife during pregnancy, brings her baby back for post‑natal checks, returns for immunisation, and is visited at home by community health workers, those contact points can be used to layer additional life‑saving interventions. The alternative is what we see too often: a burst of effort around childbirth, followed by silence.

In this context, initiatives like SARMAAN point to what a more integrated approach can look like. SARMAAN works through mothers in high‑risk communities to expand access to azithromycin mass drug administration for children aged one to 59 months, as part of broader child survival efforts. The idea builds on a growing body of evidence from large trials in West Africa, which have found that in very high‑mortality settings, giving azithromycin to young children a few times a year can reduce overall child deaths. In Niger, for example, biannual azithromycin distribution to children under five was associated with a notable reduction in all‑cause mortality over the course of the studies. The medicine is not a magic bullet, and it must be used carefully, with attention to antimicrobial resistance, but it offers a concrete way to cut through the web of infections that claim so many young lives.

What makes SARMAAN especially important is how it positions mothers at the centre. Rather than creating a separate, stand‑alone campaign, it deliberately works through the same women who attend antenatal clinics, deliver in facilities and return for post‑natal visits. A mother who has been treated with dignity in pregnancy, who trusts her local clinic because it saw her safely through labour, is more likely to accept azithromycin for her toddler, complete routine immunisation and seek care early when danger signs appear. In that sense, SARMAAN does not sit beside maternal health efforts; it sits with them, using existing trust and contact points to deliver additional child survival interventions at scale.

The programme also contributes to policy and systems conversations. By generating local data on coverage, safety, community acceptance and feasibility, it gives Nigerian decision‑makers concrete evidence on how azithromycin mass drug administration can complement, rather than replace, routine child health services and primary health care strengthening. It offers a practical model for how to layer targeted, evidence‑based child survival tools onto maternal and newborn care platforms that already exist in states and local government areas, rather than building new vertical projects from scratch.

Nigeria has committed to ambitious global targets on maternal and child mortality, but the current numbers show how far there is to go. An under‑five mortality rate that still hovers around 110 deaths per 1,000 live births and a maternal mortality ratio among the highest in the world are not just statistics; they represent the daily reality of families who do everything they can and still lose children and mothers to preventable causes. If the country is to change that story, it must stop drawing a line at the delivery room.

Protecting children needs to be seen as part of the same commitment to care that begins in pregnancy. That means financing and staffing primary health care centres that stay open and stocked, supporting frontline workers, and designing programmes that recognise mothers as partners rather than obstacles.

It means using every contact with the health system to extend care further into childhood, not closing the file once a baby is born. Initiatives like SARMAAN show that it is possible to turn dry statistics into concrete action by backing mothers, closing the gap between delivery and early childhood, and treating child survival as the natural extension of maternal health.

Source: SARMAAN Advocacy team