Maternal outcomes in the context of free maternal healthcare provisioning in north central and south western Nigeria

Abstract

Most maternal deaths are avoidable, if quality life-saving interventions are available and accessible. However, inequality in access remains a major hindrance, particularly in low and middle-income countries. Many countries in sub-Saharan Africa, have introduced free maternal healthcare to improve the utilisation of skilled birth facilities and reduce inequalities of access to these and other maternal healthcare services. However, poor utilisation rates and disparities in access to maternal healthcare services persist, and these are not adequately explained by the varied challenges associated with policy implementation. This paper examines maternal outcomes in the context of free maternal healthcare in Nigeria, which accounts for fully 19% of global maternal deaths. Specifically, it examines the effects of free maternal health policy on maternal healthcare utilisation, inequality in access to maternal healthcare services, and health system function, as well as user perceptions and experiences of free maternal healthcare services in two main regions of the country. In the main, the paper argues that there are other barriers to service use, apart from financial ones, and addressing issues related to culture and contextual differences are crucial for reducing inequality in access to maternal healthcare.