Pregnant Nigerian women need faster access to hospitals – technology helped us calculate travel times

Nigeria contributes 28% of the 280,000 maternal deaths and about 10% of almost two million stillbirths that occur annually across the globe.

Evidence shows significantly higher odds of maternal deaths in urban Nigeria than in rural areas, especially in the south, due to poor road infrastructure, haphazardly built environments, traffic congestion and expanding informal settlements.

According to research published in 2019, 82.5% of stillbirths in Nigeria occurred in urban areas.

I am a maternal health expert and co-authored two studies using Google Maps to accurately calculate travel time to obstetric care facilities in urban Nigeria.

Over 50% of maternal deaths and stillbirths in Nigeria can be averted if pregnant women get access to critical maternity services.

In Lagos – the most populated city in Nigeria with approximately 16 million people – the odds of
stillbirth and maternal death are significantly higher when pregnant women take more than 10 minutes to travel to a healthcare centre.

What has been done before and what we did now

Previous methods used to estimate travel time to emergency obstetric care have either used self-reported travel times or mapped journeys to the nearest facility. These methods have been shown to not fully reflect realities, especially in urban areas, which limits their relevance for policy and service planning.

In two studies recently published in The Lancet Global Health and Nature’s Communication Medicine, members of the OnTIME Consortium and Google pioneered an innovative approach using software that captures travel time that is closer to reality.

Using Google Maps, we assessed driving time to emergency obstetric care in the 15 most populous cities in Nigeria. These cities all have a population of over one million with a total of 11.5 million girls and women of child-bearing age, between 15 and 49 years old.

Driving times to public and private facilities were calculated. We checked that these facilities provided emergency obstetric care.

What we found

Travel time was generally longer during weekdays between 6pm and 8pm, and shortest during the weekend, between 1pm and 3pm.

• Under peak traffic conditions, women living in Nigerian cities were, on average, within a 45-minute drive to the nearest public hospital and within 30 minutes of the nearest public or private hospital.

• Travel time ranged from less than 10 minutes to the nearest public hospital in the inner city to over an hour – and even up to two hours – when travel started from the suburbs and slums.

• Between 33% (in Aba) and 97% (in Maiduguri) of women lived within 30 minutes of their nearest public hospital.

• Between 75% (in Aba) and 98% (in Ibadan, Ilorin, Lagos and Maiduguri) of women lived within 30 minutes of their nearest public or private hospital.

• Benin City, Port Harcourt, Kaduna, Abuja and Jos had the most unequal travel times. Service provision seemed skewed towards the wealthiest places, leaving the vast majority of people with little to no service.

• The wealthiest 20% across all cities had the shortest travel time and vice versa for the least wealthy 20%.

What needs to be done

The Nigerian government needs to invest in systems that support pregnant women to reach such health facilities, especially in the highly populated cities.

Urban re-design should include ambulance-only lanes and direct passes to hospitals.

Commuters need to be made aware of the need to give way to emergency vehicles.

Looking forward

Increasing rates of urbanisation, expansion of urban slums, poorly maintained roads and increased traffic congestion mean this problem will get worse if not addressed.

However, the challenge of urbanisation is not limited to Nigeria. Two-thirds of the world’s population will live in urban settings by 2050, which will put pressure on already overstretched resources in urban settings. Nearly 50% of the world’s additional 2.5 billion urban residents will be concentrated in African cities.

This increased urban population will put pressure on already overstretched resources in urban Africa, and the rapid nature of such an increase makes effective management and planning essential.