“When mothers die, who asks why? Investigating a maternal death is not an accusation against the healthcare worker. It is a patient-safety mechanism.”
When an aircraft accident occurs in Nigeria, the Accident Investigation Bureau (AIB) examines what happened, identifies contributing factors, and makes safety recommendations. The purpose is not to assign blame. It is to prevent the next accident.
When a woman dies in childbirth in a Nigerian hospital, where is the equivalent system?
The Death Certificate records “maternal complication.” The ward moves on.
And six months later, another woman dies in the same facility, from the same cause, for the same reason — because nobody was required to ask why, and nobody was required to change anything.
This is a legal article about a broken chain: death, investigation, accountability, institutional learning, prevention, dignity. In Nigeria, that chain breaks at the second link.
Maternal Death And The Scale Of Silence
Nigeria records among the highest maternal mortality ratios in the world. The World Health Organisation (WHO) estimates approximately 1,047 deaths per 100,000 live births — placing Nigeria second globally in absolute numbers, accounting for over one-quarter of all maternal deaths worldwide.
The vast majority of these deaths result from medically manageable conditions: postpartum haemorrhage, eclampsia, sepsis, obstructed labour. WHO classifies the leading causes as largely preventable with skilled attendance, essential medicines, and timely referral.
But prevention requires knowledge. And knowledge requires inquiry. When a health system records a death but does not investigate its causes, it cannot learn. When it cannot learn, it cannot change. And the same failure kills the next patient.
The Ondo State Example
In 2009, Ondo State, under Governor Olusegun Mimiko, launched Nigeria’s first Confidential Enquiry into Maternal Deaths — a systematic, independent review of every maternal death by a multidisciplinary committee.
The enquiry examined not only what killed each woman, but whether she had antenatal care, whether she was referred late, whether the facility had blood, whether the ambulance had fuel.
Between 2012 and 2015, the state’s reported maternal mortality ratio fell from 253 to 170 per 100,000 live births — a 33 per cent reduction. The state responded with staff training, tricycle ambulances, and subsidised transport for women in labour.
The study authors cautioned that other factors may have contributed and that statistical significance was not definitively established. But even if the enquiry was only one factor, it provided something most states still lack: a structured mechanism for turning death into data, and data into action.
Ondo State proved that inquiry is possible. The question is why the 35 other states have not followed.
The Missing Law
Nigeria has a Maternal and Perinatal Death Surveillance and Response (MPDSR) system. It has guidelines, training manuals, and a steering committee. What it largely lacks is legal compulsion.
In 2020, the Federal Ministry of Health developed a MPDSR Bill. In June 2022, the then minister stated it had been passed by the National Assembly and was awaiting Presidential assent. As of August 2026, there is no confirmed public record that assent has been granted.
Without that signature, maternal death investigation remains voluntary in most of Nigeria.
Only Ebonyi and Kogi have enacted dedicated MPDSR legislation. In the other 35 states, a hospital is not legally required to report a maternal death, examine the circumstances, or demonstrate what has been changed so the next woman does not die the same way.
This is not a criticism of doctors and nurses, who serve under impossible conditions. It is a criticism of a legal architecture that expects health workers to learn from deaths without giving them the protected, mandatory, independent structure that makes learning possible.
The Legal Framework That Exists
The National Health Act 2014 prohibits any health establishment from refusing emergency medical treatment for any reason. Violation is a criminal offence punishable by a fine of ₦100,000, imprisonment up to six months, or both.
When a woman dies after being refused emergency obstetric care, the circumstances warrant examination as both a clinical and legal matter.
The Constitution guarantees the right to life under Section 33 and dignity under Section 34.
The Supreme Court has held that constitutional provisions must be read together — the “whole or community reading rule.”
A system that records deaths but does not investigate whether they resulted from systemic failure or denial of care raises serious questions about whether the state is fulfilling its procedural obligation to protect life.
This column does not argue that every maternal death is a constitutional violation. That requires case-by-case analysis. But a system that systematically fails to investigate preventable deaths undermines the very protections the Constitution promises.
The right to life carries a procedural dimension: when death occurs where the state has assumed a duty of care, the state has an obligation to inquire.
Investigation Is Not Punishment
Investigating a maternal death is not an accusation against the healthcare worker. It is a patient-safety mechanism. When an accident investigator examines a plane crash, the goal is not to imprison the pilot. It is to understand whether the crash was caused by pilot error, mechanical failure, or weather — so regulators can prevent recurrence.
Similarly, when a woman dies from postpartum haemorrhage in a hospital with no blood, the inquiry should ask: Was the blood bank empty because of supply chain failure? Budget shortfall? Management decision? The doctor is often as much a victim of the system as the patient. Investigation protects both by identifying the root cause.
Without this distinction, health workers fear death reviews will become witch-hunts. That fear is legitimate and must be addressed through legal indemnity and a focus on systems rather than individuals. But the answer is not to abandon investigation. It is to design it properly.
What Must Change
If the chain from death to dignity is to be repaired, three things must happen now.
First, the President must grant assent to the MPDSR Bill. A national legal framework for mandatory maternal death surveillance is the foundation of institutional learning. Every month of delay is a month in which deaths are recorded but not examined.
Second, every state should establish an independent Maternal Death Review Commission with statutory powers — not a hospital committee reviewing its own staff, but an independent body with power to subpoena records and recommend systemic changes. Independence is the difference between genuine inquiry and institutional self-protection.
Third, the National Health Act’s prohibition on refusal of emergency care must be enforced. Section 20 exists. It has penalties. But there is no public record of any prosecution under it. A law that is not enforced is a promise written in disappearing ink.
The Bottom Line
A family that loses a mother in childbirth deserves more than a Death Certificate. It deserves an answer. An answer to what happened. An answer to why it happened. An answer to what has been changed so that it does not happen again.
The right to life in Section 33 carries a procedural expectation: when the state assumes responsibility for healthcare, and death occurs in that care, the state will inquire.
The right to dignity in Section 34 is the right of the deceased and her family to be treated as persons whose loss matters enough to understand.
When a state records thousands of maternal deaths and does not systematically investigate them, it is not merely failing its health system. It is failing its most fundamental obligation — the obligation to learn from death so as to protect life. And that failure is not administrative. It is a breach of the social contract.
Every woman who walks into a Nigerian hospital to give birth deserves to walk out holding her baby. But if she does not, she deserves the dignity of an answer. An answer that might save the next mother who walks through that same door.
Because a death that is not investigated is a death that is not counted. And a death that is not counted is a death that will happen again.
•Sanu is a Nigerian lawyer, researcher and health law scholar. This column examines contemporary health policy and legal issues through the lens of accountability, justice and human dignity.
