In Nigeria, money and men decide when a woman seeks prenatal care

At dawn, before generators roar and traders begin calling customers, Fatima is already at work in Mokola Roundabout in Ibadan, one of Nigeria’s largest cities. The 26-year-old hairdresser works long hours in the market. “The vomiting started badly, every morning before work,” she says in retrospect. It was her second pregnancy, yet she did not visit a clinic until she was almost four months gone. 

“I wanted to go earlier,” Fatima explains. “But my husband said we should wait. He said the clinic would cost too much, and his mother said women in her time didn’t need hospital care unless something was wrong.” By the time Fatima finally attended antenatal care, the journey alone left her exhausted. “The sun was hot,” she says as she recalls carrying her belly on a motorcycle taxi and being afraid something might happen.

Situations like this are common in Nigeria. Women often have to wait much longer than recommended before seeking prenatal care. However, the reasons for this have less to do with access to healthcare and more with traditional gender roles. 

“Their husband said to wait”

In Fatima’s case too, it was her husband, Yusuf, who decided when she could go to the hospital. Yusuf, who works as a mechanic, describes his decision as practical. For him, providing financially also means that he decides how resources are used. “I provide, so I must manage the money well,” he says and lists the costs: consultation fees, laboratory tests, prescribed drugs, transport. “If you go every month, it adds up,” he says. 

Until recently, he believed that women should not go to the hospital any earlier than necessary. “Pregnancy is natural,” he says. “Our mothers gave birth without all these tests.” He admits, however, that he did not fully understand what antenatal visits involve. “I thought it was routine checking.” Such views are common in many Nigerian households, where men control finances and older relatives shape health decisions. Fatima’s mother-in-law, Mama Rahmatu, says she advised patience. “In our days, we used herbs and prayer,” she recalls. “Hospitals were for emergencies, when labour was difficult.” In her opinion, “too much hospital” makes women afraid. She also expresses concern about medical interventions. “Now they are quick to cut,” she says. Yet she acknowledges that times are changing.

Health workers say they face these family dynamics daily. Chioma, a midwife at a primary health centre in Ibadan, describes how women often arrive at a late pregnancy stage. “Many come in the second or third trimester,” she says. “Some come for the first time when labour has already started. When we ask why, they say their husband said to wait, or money was not available, or their mother-in-law said attending a clinic was unnecessary.”

Early visits allow screening for anaemia, hypertension and infections, as well as counselling on nutrition and birth preparedness. “When women come early, we can prevent many complications,” Chioma explains. “When they come late, we are managing existing problems.”

Nigeria’s maternal mortality

At the national level, Nigeria continues to face one of the highest maternal mortality ratios worldwide – 993 deaths per 100,000 live births in 2023, according to WHO data. The African average was 442. A survey conducted among 1915 reproductive-aged women across Nigeria in 2022 found that only about 53 % accessed some antenatal care. There are serious inequalities linked to income, location and decision-making power within the household.

In Ibadan, clinics are present and awareness is gradually increasing. But changing mindsets takes time, because generational beliefs and gender roles are deeply ingrained, and decisions about when to seek care reflect economic pressure. Improving maternal health outcomes, health workers suggest, requires not only medical services but broader engagement with families who ultimately shape those decisions.

Fatima’s delayed visit had consequences. At her first appointment, she was diagnosed with anaemia. “The nurse asked why I came late,” she says quietly. She received iron supplements and monitoring. Her baby was born underweight but healthy. Looking back, Fatima speaks carefully about what she learned. “Next time, I will save a little money myself,” she says – a modest attempt to become financially independent. Yusuf says his understanding has changed. “I did not know it was that serious,” he admits. “If she gets pregnant again, I will go with her.”

Oluwatoyosi Asunmo is a population health research analyst based in Nigeria. She is also a fashion entrepreneur at CREGO House.
ifeoluwapo19@gmail.com