Why Some Policies Reduce Maternal Mortality in Sub-Saharan Africa While Others Fail

In sub-Saharan Africa, maternal mortality remains one of the most urgent health challenges. Despite international commitments, the region accounts for nearly 70% of global maternal deaths. A recent analysis of health policies in Nigeria, Rwanda, South Africa, and Gabon reveals that success does not depend solely on the existence of laws, but primarily on their implementation.

Rwanda has seen a significant decline in maternal mortality, dropping from 320 to 200 deaths per 100,000 live births between 2014 and 2023. This progress is explained by a coherent national strategy: decentralized funding, performance-based remuneration for healthcare workers, and the integration of community health workers. These professionals, trained and deployed in rural areas, have strengthened access to prenatal care, safe delivery, and postnatal follow-up. A community insurance system has also helped reduce financial barriers, while regular health data has enabled real-time policy adjustments.

In South Africa, maternal mortality has decreased thanks to the integration of HIV prevention services and maternal health care. Universal access to antiretrovirals and improved obstetric audits have played a key role. However, inequalities persist between urban and rural areas, where infrastructure and staff are still lacking.

Gabon has implemented mandatory insurance and targeted subsidies to facilitate access to care. While these measures have reduced financial barriers, especially in cities, rural regions still suffer from shortages of personnel and transportation. Maternal mortality there has decreased from 261 to 220 deaths per 100,000 live births, but progress remains uneven.

In Nigeria, the situation is more concerning. Despite reforms, maternal mortality remains very high, at around 917 deaths per 100,000 live births. The fragmentation of the governance system, underfunding of primary care, and disruptions caused by the COVID-19 pandemic have hindered progress. Disparities between states and the lack of rigorous monitoring of allocated funds are worsening the situation.

This comparison shows that countries that have successfully reduced maternal mortality have combined stable funding, transparent management, and strong community engagement. Rwanda and South Africa illustrate the importance of investing in healthcare worker training, infrastructure quality, and the involvement of local populations. Conversely, Nigeria and Gabon demonstrate that poorly implemented policies, even if well-designed, are not enough to save lives.

Equitable access to care appears to be a decisive factor. Rural areas and disadvantaged populations, particularly adolescents, remain the most vulnerable. The lessons learned from these experiences highlight a central point: to achieve the Sustainable Development Goals, it is not enough to adopt laws; they must be rigorously applied and solutions must be adapted to local realities. Political stability, financial transparency, and community participation are essential to turn promises into concrete results.

Legal References

Reference Work

DOI: https://doi.org/10.1186/s12982-026-01765-w

Title: Maternal mortality and health policies in Sub-Saharan Africa insights from Nigeria Rwanda South Africa Gabon

Journal: Discover Public Health

Publisher: Springer Science and Business Media LLC

Authors: Ezinne Victory Kanu; Charles Chibuisi Ehiemere; Ishaku Adamu Akyala; Eric Terkuma Chia; Zakari Abubakar