Maternal and child health (MCH) outcomes in Nigeria are very poor. The NDHS 2008 found that the infant mortality rate is 75 deaths per 1000 live births; under fives mortality is 157 deaths per 1000 live births, and neonatal mortality rate is 40 per 1000 live births. The estimated maternal mortality ratio during the seven year period prior to 2008 is 545 maternal deaths per 100,000 live births. Inadequate health facilities, lack of transportation to institutional care, inability to pay for services and resistance among some populations to modern health care are key factors behind these high rates of maternal, newborn and child mortality and morbidity (Babalola, 2009, UNICEF 2008).

The situation in northern Nigeria is critical where strong cultural beliefs and practices on childbirth and fertility-related behaviors partly contribute significantly to the maternal morbidity and mortality picture (Wall, 1998) compared to southern Nigeria. These beliefs and practices include: an Islamic culture that undervalues women; a perceived social need for women’s reproductive capacities to be under strict male control, the practice of wife seclusion which restricts women’s access to medical care, almost universal female illiteracy, marriages at an early age and pregnancy often occurring before maternal pelvic growth is complete, a high rate of obstructed labour, directly harmful traditional medical beliefs and practices and inadequate facilities to deal with obstetric emergencies.

Reports of the NDHS 2008 show that 58% of women age 15-49 received antenatal care (ANC) from a skilled provider during their last pregnancy . Women in the urban areas and in the South were much more likely to receive ANC than their rural and northern counterparts: 51.2 % and 67.1 % of mothers in the North East and North West, respectively, did not receive ANC, which was a decrease on participation from the NDHS 2003 results of 47% and 59%.

A study of MCH use in the three northern states of Katsina, Yobe and Zamfara interviewed over 7,000 women (Doctor et al 2011). This study found very low utilization of ANC facilities, lowest vaccination rates of children compared to other countries in sub Saharan Africa and poor health seeking behaviours. Only 24.9% of women who gave birth in the five years preceding the survey ever received ANC from a trained health professional (i.e., a doctor, nurse/midwife), varying from a high of 32% in Katsina followed by Yobe (25.5%) to a low of 10.5% in Zamfara. This means that 75.1% of women in the three states never sought health advice. Most women receiving ANC began their visits during the second trimester. About 3% of women sought advice from their friends, with a similar proportion seeking advice from co-wives. Knowledge of complications during pregnancy can reduce the risk of death. The results show that more women in Yobe (12.7%) did not know about any complications compared with women in Zamfara (6.8%) and Katsina (1.3%).

For all live births in the past five years, only 11.2% reported that their births were delivered by a health professional, only 9.4%, delivered in a health facility. Home deliveries are nearly universal (87.2% of all women reporting home delivery). About 95% of women in Zamfara reported home deliveries, compared with 87.2% and 82.3% in Yobe and Katsina respectively: corresponding figures from the Nigeria 2008 DHS are 92.3%, 92.9%, and 93.1% respectively. For women who deliver at home, the most common reason cited was that it is more comfortable to deliver at home than at a facility (43.8%).

Agee ‘s (2010) analysis of the NCDS 2003 (using a sample of 1359 households) confirms many of the preceding findings: that family wealth and region specific knowledge (primarily not knowing where to go) about community health access positively affects nutritional status, and that these gains can be supported by differences in mother’s education and her access to community health services.

Child Immunisation

Data from the NDHS 2008 shows the national vaccination coverage for children age 12-23 months. Overall 23 % of these children are fully vaccinated, a doubling of vaccination coverage from the estimate of the NDHS in 2003 (13 %). Overall 29% of children in Nigeria have not received any vaccinations. In the NC and NE States, 25.9 % and 7.6 % had received all basic vaccinations respectively while the figures for no vaccinations were 23.4 % and 33.3 respectively.

In the three northern states of Katsina, Yobe and Zamfara, 25% of all children aged 12-23 months had received the three recommended doses of polio, but many missed the corresponding third dose of DPT3, which was received by only 5.1% of one-year olds. Only 2.2% of children 12-23 months of age received all recommended doses. More children in Yobe (3.8%) than in Katsina (2.5%) and Zamfara (0.2%) had received all recommended doses (p=0.05). Further analysis of the data shows that 67% of parents were unable to receive all immunizations reported lack of vaccine as a problem, and 13% had difficulties with the long wait (Doctor et al, 2011) .

Children in the urban areas have consistently higher immunization rates than those in the rural areas. Overall, 4.6% of urban children 12-23 months of age had received all of the recommended doses by one year, compared to 1.1% in the rural areas. The greatest urban advantage is associated with the BCG dose, which is administered at birth and probably reflects the higher proportion of births in health care facilities in the urban areas. For DPT3 and Polio3 the urban and rural rates are much closer.