Pregnancy and childbirth remain dangerous for many women globally. Complications such as severe bleeding and hypertensive disorders can become life-threatening, particularly when timely and appropriate healthcare is unavailable.
Around 70% of maternal deaths worldwide occur in sub-Saharan Africa. This is largely because many women still face barriers to timely and good quality maternity care. There are also shortages of skilled health workers and essential medical supplies.
Nigeria contributes a substantial share of these deaths, despite years of investment in maternal health services. Nigeria alone accounted for nearly 29% of all maternal deaths worldwide in 2023. That was an estimated 75,000 deaths, the highest number recorded for any country that year.
Using antenatal care, giving birth in a health facility and receiving postnatal care are among the most effective ways to reduce these deaths. But one group is often overlooked: women with disabilities. These women face many barriers when trying to access healthcare. They are more likely to encounter inaccessible facilities, transport difficulties, negative attitudes from healthcare workers and limited access to health information.
We are global public health researchers studying maternal and reproductive health, disability and health inequalities.
Our recent study set out to examine how women with physical or visual disabilities in Lagos, Nigeria’s commercial capital city, use essential maternal healthcare services.
We found that most of the women used maternal healthcare services, but this encouraging picture masked important inequalities. We also discovered that location, educational level, marital status and household wealth were associated with their use of care. So getting care is shaped not only by the availability of services, but also by wider social and economic circumstances.
That means tailored interventions are crucial for improving access and achieving SDG 3 targets – good health and well-being.
Read more: Sex and disability: Nigerian women share their stories
What we did
Using a questionnaire, we interviewed 250 women with physical or visual disabilities living in Alimosho and Ikorodu, two large and dense local government areas of Lagos State, south-western Nigeria. Both areas have urban and rural divisions.
The survey in late 2024 included women with disabilities who had given birth within the previous 12 months.
We asked whether they had attended antenatal care during pregnancy, given birth in a health facility, and received postnatal care. We also examined how factors such as education, wealth, marital status and place of residence influenced service use.
Our findings
The findings were encouraging. More than eight in 10 women attended antenatal care while seven in 10 gave birth in a health facility. Nearly eight in 10 received postnatal care after delivery.
These levels of maternal healthcare use are higher than those reported for women with disabilities in several other low- and middle-income countries, including Ethiopia, Nepal and Pakistan. They are also higher than the national averages reported in Nigeria’s 2018 and 2024 Demographic and Health Surveys for all women.
In 2018, 67% of Nigerian women received antenatal care, while 39% gave birth in a health facility and 42% received postnatal care. The 2024 Nigeria Demographic and Health Survey reported that 63% received antenatal care from a skilled provider, while 43% gave birth in a health facility and about 43% received a postnatal check within two days of giving birth. In our study, the corresponding figures were 82.4%, 70.4% and 78.4%.
However, looking only at the overall figures hides important inequalities. Women living in Ikorodu, a large and rapidly growing area outside the city of Lagos, were much more likely to use all three maternal health services than those living in Alimosho, a densely populated urban area within metropolitan Lagos.
Education also made a major difference. Women with secondary or tertiary education were more likely to attend antenatal care and give birth in a health facility. They were also more likely to receive postnatal care than those with no formal education.
Marriage mattered too. Married women consistently had better maternal healthcare use than unmarried women. Possibly, married women may have greater financial, practical and social support from their partners, making it easier to pay for care, arrange transport and attend health facilities.
Household wealth also influenced access. Women from wealthier households were more likely to use essential maternal health services than those from poorer households.
Why these findings matter
Women with disabilities are reported to face barriers to maternal healthcare, including inaccessible facilities, discrimination and communication difficulties. Our study adds nuance: many women with disabilities in Lagos are using maternal health services, but access remains uneven.
Where a woman lives, her level of education, whether she is married, and her economic circumstances continue to shape whether she receives essential care during and after pregnancy. These inequalities are not unique to women with disabilities.
This means that improving maternal health is not simply about increasing the number of health facilities. It also requires tackling the social and economic inequalities that prevent some women from benefiting from available services.
Read more: Sexual health is an extra struggle for women with disabilities: findings from 10 African countries
What should happen next?
Nigeria has committed to reducing maternal deaths to fewer than 70 deaths per 100,000 live births by 2030. This is from an estimated 1,047 deaths per 100,000 live births in 2020. To achieve this, maternal healthcare must become more inclusive for women with disabilities. That means:
-
reviewing maternal health programmes to ensure they meet the needs of women with disabilities
-
training healthcare workers to provide respectful and appropriate care
-
reducing financial barriers
-
helping women with transport to reach health facilities.
Other countries offer useful lessons. Nepal has made disability inclusive care part of midwifery training. Rwanda has trained nurses and midwives in disability inclusion and sign language.
More research is also needed across different parts of Nigeria, especially those experiencing conflict and displacement. That will provide a better understanding of how women with disabilities experience pregnancy, childbirth and postnatal care, and how health systems can better respond to their needs.
Comments are closed.