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Accessing healthcare: An arduous journey for pregnant women in northwest Nigeria
Accessing healthcare: An arduous journey for pregnant women in northwest Nigeria
By: Michael Mike
In the bustling emergency ward of Jahun General Hospital’s maternity department, the rhythm of activity beats with urgency and determination, like a pulse in the air. In this hospital, Médecins Sans Frontières (MSF) collaborates with the Jigawa state Ministry of Health to provide comprehensive emergency obstetrics and newborn care and fistula care. Since commencing services in 2008, MSF teams have assisted 90,000 deliveries.
Nigeria is the third country in the world, after South Sudan and Chad, where a woman is most likely to die giving birth, according to the World Health Organisation. With an average of more than 1,000 maternal deaths per 100,000 live births each year, Nigeria is far from the global target for 2030 of less than 70 maternal deaths per 100,000 live births, as set under the UN Sustainable Development Goals.
Maternal mortality rates far exceed the country average in northern Nigeria, where more than half of the country’s estimated 200 million people live. In Jigawa state, the most significant factor is the limited access pregnant women have to antenatal care and delivery care for complications in childbirth, which frequently occur.
Unity Enuebuke, MSF Nursing Activity Manager, has been working in Jahun General Hospital for more than 10 years. “We see a lot of women with serious complications, with the most common ones being anaemia, haemorrhage and eclampsia,” she explains. The high number of patients means the maternity wards are often fully occupied, if not over capacity. Unity says, “We regularly have up to two women sharing a bed, and depending on the type of complications we see, things can escalate very quickly.”
Ramatu
Ramatu, a mother of two, suffered life-threatening eclampsia—seizures due to high blood pressure—when she delivered her first baby in Jahun hospital. This is her second time here, overcoming the considerable distance from home. “I live five hours away from Jahun General Hospital. There is no hospital where I live, and the closest one does not open at night,” she explains. In Jigawa state, many of the estimated 749 primary healthcare centres do not have the drugs, healthcare workers and medical equipment to serve the thousands of women of childbearing age, despite efforts from public health authorities, the current healthcare infrastructure does not come close to meeting the needs of the population.
This dire situation leaves pregnant women who want to attend a healthcare facility with limited choices such as giving birth at home, and if complications arise, embarking on a treacherous journey to try to reach one that is functioning.
It is also not enough that healthcare facilities are available, they must also be affordable. The economic reality in this region, worsened by soaring inflation rates, makes it difficult for people to afford hospital fees, drugs or even transportation to health facilities.
The result is that women become hesitant to go to the hospital, preferring to give birth at home with the help of more affordable traditional birth attendants, hence increasing the risk of experiencing complications.
Khadijah
Women have given birth at home for centuries, but mother’s and baby’s survival can hinge on preparing and planning for managing complications, which may also occur without warning. In Jigawa state, health professionals and facility-based delivery rates remain low with up to around 80% of deliveries occurring at home.
Nurse Unity says, “Most times, family members don’t bring the mother to the hospital until they see that the baby is not coming out and the mother herself is having seizures.”
Khadijah, a 58-year-old traditional birth attendant in Aujara community, Jigawa state, understands the value of hospital care if she can’t manage a complication, but has experienced women’s hesitation firsthand. “Some women take my advice when I say they should go to the hospital, while some refuse to go to the hospital because they say that they are used to giving birth at home.”
In many communities in Jigawa state, pregnant women often require permission from their husband or mothers-in-law to visit hospital. This practice is compounded by a trend of early marriage, at an age when women are not fully informed about pregnancy and are not physically ready to carry a child.
Khadijah explains that for some, “it is their husbands that prevent them from going to the hospital. Some men don’t see the relevance of antenatal care, while others don’t want another man to treat their wives.”
1.
What needs to be done?
To tackle maternal mortality, a multitude of factors must be addressed. State authorities and international organisations must scale up their activities and increase funding to healthcare in the region, ensuring that budget allocations for primary healthcare centres are properly utilised and thorough planning and strict implementation processes are in place. In 2023, MSF teams assisted 15,754 deliveries, performed 1,911 caesarean sections and completed 43,785 antenatal consultations. Yet, it is still a drop in the ocean when looking at the needs of women in Jigawa state.
Primary healthcare facilities, which are often the first point where pregnant women seek healthcare, need to be equipped with trained personnel, equipment and resources to manage childbirth-related complications. “Eighty two percent of the cases we receive at Jahun General Hospital are complicated cases that could have been prevented at the primary healthcare level.” says Abdulwahab Mohamed, MSF medical coordinator. “Women, especially those of childbearing age, also have to be informed about their health and wellbeing through health empowerment programmes led by state authorities or other health stakeholders”.
Pregnant women must be encouraged to go for antenatal care where they can be informed about their pregnancy journey and what to expect. Efforts must be made to mitigate cultural practices that hinder women from seeking care in medical facilities. Women should be allowed agency and given freedom to make decisions for their health.
MSF supports the Jigawa state Ministry of Health in providing comprehensive emergency obstetrics and newborn care. Our support started with vesicovaginal fistula repair in 2008, however, the project evolved into a 161-bed facility to care for pregnant women and newborns experiencing complications. MSF teams also provide maternal and neonatal healthcare in the states of Kano, Benue, Cross River, Zamfara and will open a large maternity hospital in Maiduguri in June 2024.
Accessing healthcare: An arduous journey for pregnant women in northwest Nigeria
News
Seven dead, five injured in multiple-vehicle crash along Lokoja–Abuja highway
Seven dead, five injured in multiple-vehicle crash along Lokoja–Abuja highway
By: Zagazola Makama
At least seven persons were killed and five others injured on Tuesday morning in a multiple-vehicle collision along the Lokoja–Abuja highway near Gadabiu Village, Kwali Local Government Area of the Federal Capital Territory (FCT).
Sources told Zagazola Makama that the accident occurred at about 9:00 a.m. when a Howo truck, with registration number ANC 665 XA, driven by one Adamu of Tafa Local Government Area, Kaduna State, lost control and rammed into three stationary vehicles parked along the road.
The affected vehicles included a Golf 3 (GWA 162 KZ), another Golf and a Sharon vehicle.The drivers of the three stationary vehicles are yet to be identified.
The sources said the Howo truck had been travelling from Okaki in Kogi State to Tafa LGA in Kaduna State when the incident occurred. Seven victims reportedly died on the spot, while five sustained various degrees of injuries, including fractures.
The injured were rushed to Abaji General Hospital, where they are receiving treatment. The corpses of the deceased have been released to their families for burial according to Islamic rites.
The police have advised motorists to exercise caution on highways and called on drivers to ensure their vehicles are roadworthy to prevent similar accidents in the future.
Seven dead, five injured in multiple-vehicle crash along Lokoja–Abuja highway
News
How misdiagnosis, narratives are fuelling Nigeria’s banditry escalation
How misdiagnosis, narratives are fuelling Nigeria’s banditry escalation
By: Zagazola Makama
Nigeria’s banditry crisis is no longer escalating simply because armed groups are growing bolder. It is escalating because the country continues to misdiagnose the threat, apply blunt policy tools to differentiated actors, and unintentionally feed a violent criminal economy through ransom payments, politicised narratives and delayed state consolidation.
Across the North-West and parts of the North-Central, banditry has evolved beyond rural violence into a structured, profit-driven security threat. Yet public debate remains trapped between emotional appeals for dialogue and absolutist calls for force, leaving little room for the strategic clarity required to halt the violence.
At the heart of the escalation is money. Banditry today survives on a diversified revenue architecture that includes ransom payments, cattle rustling, illegal mining, arms trafficking, extortion levies on farming and mining communities, and collaboration with transnational criminal networks. Each successful kidnapping or “peace levy” reinforces the viability of violence as a business model.
Data released by the National Bureau of Statistics (NBS) in December 2024 underlined the scale of this economy with the North-West accounting for the highest number of kidnap incidents and victims.
Zagazola argue that as long as communities remain unprotected and ransom payments continue as a survival strategy, banditry will regenerate faster than military operations can suppress it. This is not ideology-driven violence at its core; it is cash-flow-driven criminality as every payment funds the next attack.
Another accelerant is Nigeria’s persistent failure to differentiate categories of armed actors. Security assessments increasingly point to at least two distinct groups operating within the banditry ecosystem.
The first consists of low-level, defensive armed actors, often rural residents who acquired weapons after suffering attacks and whose violence is reactive rather than predatory. The second group comprises entrenched, profit-driven bandit networks responsible for mass kidnappings, village destruction, sexual violence, arms trafficking and territorial control.
Yet public discourse and policy responses frequently collapse these actors into a single category of “bandits,” resulting in indiscriminate dialogue offers, blanket amnesty rhetoric or, conversely, broad-brush security operations that alienate communities. This conceptual error, allows high-value criminal leaders to masquerade as aggrieved actors while exploiting negotiations to buy time, regroup and rearm.
Dialogue has repeatedly been applied in contexts where the state lacks coercive leverage. Experiences in Zamfara, Katsina, Sokoto and Kaduna states and parts of the North-West show a consistent pattern: temporary reductions in violence following peace deals, followed by rapid relapse and escalation. Officials who participated in the dialogue have openly acknowledged that many agreements collapsed within months.
The negotiations conducted without sustained military pressure, intelligence dominance and post-agreement enforcement mechanisms merely incentivise armed groups to pause tactically. When criminals negotiate from a position of strength, dialogue becomes appeasement.
Perhaps the most dangerous accelerant is the ethnicisation of banditry. Although criminal gangs include actors of identifiable ethnic backgrounds, the violence itself is not driven by ethnic grievance. Nonetheless, selective media framing and political rhetoric like what had been witnessed in Plateau have increasingly cast banditry through identity lenses, particularly in farmer–herder contexts.
This framing obscures the criminal logic of the violence and deepens mistrust between communities that are themselves victims. In Nigeria today, the fulani herdsmen and pastoralists communities are being weaponized and stereotyped as bandits. This dangerous persecution has strengthens bandit recruitment narratives, allowing criminal leaders to cloak profit-driven violence in claims of ethnic persecution or genocide.
Historical records and sociological studies show that Fulani, Hausa, Tiv, Berom and other communities coexisted for decades through complementary economic systems. The breakdown of this coexistence has been exploited by armed groups seeking cover, recruits and informants. Security agencies possess significantly more intelligence on bandit networks than is visible in public debate. Lawful interceptions, human intelligence and post-operation assessments routinely reveal financial motives, supply routes and internal hierarchies within armed groups.
However, public advocacy for dialogue often relies on forest-level engagements that security officials describe as “theatrical performances” by bandits choreographed grievances designed to elicit sympathy and concessions. The disconnect between classified intelligence and public narratives has allowed emotionally compelling but strategically flawed arguments to dominate national discourse.
Another escalation factor is the emerging convergence between bandit networks and ideological terrorist groups as Nigeria’s internal security landscape firmly indicates that what has long been treated as banditry especially in the North-West and parts of North-Central Nigeria has evolved into a hybrid jihadist campaign, driven by Boko Haram (JAS faction) and reinforced by JNIM elements operating from Sahelian-linked forest sanctuaries. Shared arms supply chains, training exchanges and joint operations could transform banditry from criminal violence into full-spectrum insurgency if unchecked. Nigeria’s past experience with Boko Haram demonstrates the cost of dismissing such convergence as isolated or exaggerated.
Military operations have succeeded in degrading bandit camps in several corridors, but the absence of immediate governance has allowed violence to recycle. Clearing operations not followed by permanent security presence, functional courts, reopened schools, healthcare and markets leave vacuums that criminal actors quickly refill. Bandits and other criminals thrive where state authority is episodic rather than continuous. Security victories without governance consolidation merely displace violence spatially and temporally.
Therefore, Nigeria must urgently reset its approach by formally adopting threat differentiation, choking financial lifelines, regulating community defence structures, and ensuring intelligence-led, precise enforcement against high-risk criminal networks. Dialogue, they say, must be selective, conditional and embedded within formal disarmament and reintegration frameworks not deployed as a moral reflex.
Above all, the state must reclaim narrative control by defining banditry clearly as organised criminal violence, not a sociological misunderstanding. As one senior official put it, “Banditry escalates where sentiment overrides strategy. The cure begins with honesty.”
Without that honesty, Nigeria risks allowing a violent criminal economy to entrench itself deeper into the country’s security architecture at a cost measured not just in money, but in lives, legitimacy and national cohesion.
How misdiagnosis, narratives are fuelling Nigeria’s banditry escalation
News
ISWAP kills 10 JAS fighters in Kukawa as rivalry clashes escalates
ISWAP kills 10 JAS fighters in Kukawa as rivalry clashes escalates
By: Zagazola Makama
No fewer than 10 fighters of the Jama’atu Ahlis Sunna Lidda’awati wal-Jihad (JAS) were killed on Jan. 8 during a night attack by the rival Islamic State West Africa Province (ISWAP) at Dabar Ledda, within the Doron Naira axis of Kukawa Local Government Area (LGA) of Borno State.
Security sources told Zagazola Makama that ISWAP fighters launched a surprise assault on a JAS checkpoint, locally referred to as an Irasa, in the Dabar Ledda area, overwhelming the position after a brief but intense clash.
Sources familiar with developments in the area told Zagazola Makama that the attack ended decisively in ISWAP’s favour, with about 10 JAS fighters killed. Following the operation, ISWAP elements were said to have withdrawn swiftly to their major stronghold located between Kangarwa and Dogon Chuku, also within Kukawa LGA.
Both group has, in recent years, focused on degrading each other’s capabilities in an attempt to consolidate control over key corridors around Lake Chad as well as Sambisa Forest.
However, the latest clash is expected to trigger a violent response. Intelligence reports suggest that JAS leadership, acting on directives allegedly issued by Abu Umaima, has ordered mobilisation of fighters across the northern and central parts of the Lake Chad region of Borno (LCRBA) in preparation for retaliatory attacks.
The planned counter-offensive could lead to an upsurge in large-scale attacks in the days and weeks ahead, particularly around the Kangarwa–Dogon Chuku corridor, an area that has witnessed repeated factional battles due to its strategic value for logistics, recruitment and access routes.
While the infighting has historically weakened Boko Haram/ISWAP overall cohesion, Zagazola caution that intensified clashes often come at a heavy cost to civilians, as armed groups raid communities for supplies, conscripts and intelligence. Kukawa LGA, already battered by years of insurgency, remains highly vulnerable whenever such rivalries escalate.
ISWAP kills 10 JAS fighters in Kukawa as rivalry clashes escalates
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