Pregnancy has become a nightmare in Nigeria’s conflict-hit north

Aisha Muhammed was in her third trimester when she developed convulsions and high blood pressure from eclampsia — a leading cause of maternal death. Her village clinic had no doctor, and the nearest medical help was 40 kilometres away, across some of the world’s most dangerous terrain.

Muhammed eventually reached Maiduguri, where she delivered twins by cesarean section in April. “Even though children are a source of joy, if I will have to go through the same ordeal again, I am afraid of getting pregnant,” she said, holding back tears.

More women die giving birth in Nigeria than anywhere else in the world, according to the World Health Organisation. In 2023 alone, the country accounted for more than a quarter of global maternal deaths — 75,000 women. At least one in every 100 Nigerian women dies during childbirth, a grim statistic in a country of 220 million where healthcare remains chronically underfunded.

Nowhere is the crisis worse than in the northeast, where a resurgent Boko Haram insurgency and the sudden loss of U.S. aid have left maternal healthcare on the brink of collapse. Roads are closed by fighting, doctors and aid workers are fleeing, and hospitals in once-peaceful towns have been reduced to rubble or abandoned.

Read Also: How poor access to sexual reproductive health information fuels teenage pregnancy in Akwa Ibom

“We were seriously taken aback by the stop-work order, and we are seriously affected by it because we were not prepared for it,” said Abubakar Kullima, chief medical director at the Borno State Hospitals Management Board, referring to the abrupt withdrawal of hundreds of millions of dollars in U.S. support.

Between 2020 and 2025, Nigeria received nearly $4 billion from the U.S. Agency for International Development, including $423 million for maternal health and family planning. But this year, that lifeline vanished. In response, Nigeria announced an emergency $200 million health budget, a fraction of what has been lost.

For women like Falmata Muhammed, the consequences have been devastating. She went into labor in her village of Bulabilin Ngaura in 2021, but with no hospital nearby, she and her husband set out for Maiduguri, 57 kilometers away. She began hemorrhaging and delivered a stillborn child on the roadside. Now pregnant again, she lives in Magumeri, where the town’s hospital was burned in a Boko Haram attack in 2020 and replaced by a poorly equipped mobile clinic.

Aid workers say more mothers are dying because they cannot reach care. Recruiting doctors has become nearly impossible, with salaries in Borno as low as $99 to $156 a month. “There have been times when there were advertisements, but nobody is willing,” said Dr. Fanya Fwachabe, Borno’s sexual and reproductive health manager for the International Rescue Committee, one of the last international NGOs still operating in the state.

The Nigerian government insists it is committed to security and healthcare reforms, but for many expectant mothers, pregnancy has become a matter of survival. “If you count five people away, you know a woman who has probably had an issue with maternal morbidity or mortality,” said Jumoke Olatunji, cofounder of the Alabiamo Maternal and Child Wellbeing Foundation in Lagos.

As Boko Haram attacks mount and aid dwindles, the odds for pregnant women in Nigeria’s northeast remain dire — where bringing life into the world too often comes at the cost of their own.