Experts at the Nigerian Institute of Medical Research (NIMR) have called on the government to implement a national maternal mortality and infant mortality audit, with mandatory autopsies for maternal deaths.
They argue that such a move is essential to accurately determine the causes of death and develop effective preventive strategies.
Speaking at the institute’s monthly media chat, Director-General of NIMR, Professor Oladapo Obafunwa, questioned the reliability of current maternal mortality statistics in Nigeria. He stressed the need for a legal framework mandating autopsies in maternal deaths to better understand the true causes and inform national health interventions.
“How exactly did we arrive at the maternal mortality statistics that Nigeria has today?” he queried. “We need a nationwide coronial law that mandates autopsies in such cases. Without proper investigations, we are only scratching the surface.”
Obafunwa noted that most available data on maternal deaths may be skewed, often derived from tertiary healthcare facilities where only the most critical cases are referred. “What are the chances of that woman dying? Of course, you have the problems of fistula formation,” he added. “But many normal deliveries occur at secondary or primary care centres, or even with traditional birth attendants. These are rarely captured in official data.”
He also highlighted systemic issues such as poor access to hospitals and the dangers women face en route to care, including quackery and infrastructural deficits.
“Some of these deaths are never investigated. Unfortunately, that aspect of maternal mortality cannot be executed in isolation. It must be a national effort,” he said.
Echoing this position, Director of Research at NIMR and a consultant obstetrician-gynaecologist, Professor Oliver Ezechi, explained that most maternal deaths are sudden and unexpected, conditions that already meet the criteria for autopsy under medical law. Recalling his own training during the tenure of the former Health Minister, he described a time when every maternal death had to be formally reported and reviewed in hospitals.
“I remember cases where we all thought a woman died of pre-eclampsia, only for the pathologist to reveal it was actually an amniotic fluid embolism, a diagnosis we couldn’t have made without an autopsy. Those reviews were not to blame anyone, but to learn. Lessons learned saved lives,” he said.
According to Ezechi, a proper audit would bring together pathologists, obstetricians, and other healthcare professionals to collectively establish the cause of each maternal death, draw actionable insights, and prevent future occurrences.
“Globally, the three leading causes of maternal death are bleeding, hypertensive disorders of pregnancy, and infection. So, the question is, why are our figures so much worse if we’re dealing with the same causes?” he asked.
He recounted a conversation with a Swedish health professor who had never seen a maternal death in his 70 years of life—an experience that starkly contrasts with the Nigerian reality.
They called on the Federal Ministry of Health to reinstate past policies requiring the investigation of every maternal death in hospitals through a non-punitive, transparent review process.
“This is not about blaming doctors or nurses. It’s about understanding what went wrong so we can fix it. Hiding the facts helps no one,” Ezechi said.
Their call reflects a broader consensus among maternal health experts that Nigeria’s high maternal mortality rate can only be tackled through systematic, evidence-based interventions, starting with the truth about why women are dying.
