ABUJA - Globally, the number of maternal deaths has been cut in half since 1990. But, in Nigeria 40,000 women die each year because of pregnancy complications. Aid organizations say poverty, isolation and dangerous traditions are the heart of the problem while some mothers say there are simply no doctors at the hospital.
A United Nations study indicates that a third of the women who die from childbirth yearly are in two countries: India, the world's second-most populated, and Nigeria, Africa's most populous nation.
The report says Nigeria also has the distinction of having one of the world's highest maternal death rates - 630 deaths for every 100,000 live births.
Bukola Danmusa is the mother of three who lives in a rundown neighborhood outside the capital. She says many women do not go to the hospital because it's too expensive.
"Some people don’t have money to go the hospital to do [pre-natal care] and the results are complications or death when they have their baby," said Danmusa.
She says, even if they go, to a hospital, there is usually no doctor and perhaps a single nurse.
United Nations Children's Fund health specialist Esther Obinya says women in rural areas often do not know the risks of pregnancy and are tended to by traditional birthing assistants who have no medical training. She says, sometimes when women in isolated villages need to go to the hospital for emergency care during delivery, the quickest available transportation could be on a donkey or a motorcycle or by foot.
"There are no helicopters to come and fish her out if she is bleeding," said Obinya. "There are no cars to flash out. The places they live in there may just be transport once a week, on market days."
Obinya says, if a woman starts hemorrhaging during childbirth, she has only a couple of hours to be treated before she dies, causing 25 percent of Nigeria's maternal deaths.
She says high maternal death rates are also a result of child marriage and social pressure to have many babies, both common in some parts of Nigeria. She says many women believe that hospitals are only for problem pregnancies and feel pressure not to burden their husbands with the costs.
Obinya notes that abortion is illegal in Nigeria, with the exception of when the woman's life is in danger. As a result, some girls get illegal abortions from quack doctors who tell patients they are fine and hurry them to the door.
"On her way home she just collapses so her friends who brought her now rushes her to the hospital, but it is too late. I've seen so many girls die like that," she said.
She says UNICEF and the Nigerian government are conducting massive awareness campaigns and training health care professionals across the country, hoping to cut the maternal death rate in half by 2015.
Hellen Akujohnson, a teacher and mother of four, says health care for pregnant women would also improve if policies already in place were enforced. She says the local government has promised free care for pregnant women and their babies until they are five years old.
However, she says, at most hospitals, care is not free because workers fleece patients for illegal fees.
"They extort money from women, collect things from them, get money from them [to] buy material things - the hospital workers who collect it from them - whereas it’s supposed to be free," said Akujohnson.
Doctors also say low salaries for medical professionals create a disincentive to work in remote rural areas. Dr. Habiba Suleiman is a general practitioner with three children. She says the government should pay doctors enough to convince them to serve where they are needed most.
"Doctors should have enough salaries that should excite them and make them want to go down to go the rural areas because this is really the primary health care centers where you can catch this patient early enough," said Suleiman.
Early this month, Nigerian officials fired nearly 800 doctors who were on strike against low wages. Suleiman says, in addition to better salaries, Nigeria needs to train more female doctors, because they will pay close attention to the needs of mothers.