LACK of trust, poorly equipped primary health centres, long distances to hospitals, and frequent staff shortages, have compelled many women in Niger State’s rural communities to resort to untrained traditional birth attendants during childbirth. The ICIR visited rural communities in the state to expose how broken healthcare systems are pushing women to risky alternatives.
Read a similar report by The ICIR on how government neglect fuels maternal deaths, sexual violence in Plateau community.
It was the middle of the night in Ibeto, a remote community in Niger State, when Fatimah, heavily pregnant and close to delivery, began to groan in pain. She had been visiting her sister’s home for two days when labour struck. By midnight, her cries of distress filled the small compound, and panic spread among the family members.
Her sister and brother-in-law quickly bundled her into a tricycle and rushed her to the nearest hospital, about 30 minutes away. There, the nurses gave them a bed, but nothing more. Fatimah’s pain worsened. She clutched her swollen belly and cried out as contractions tightened around her like a vice. Her sister pleaded with the nurses to take her to the labour room, but they refused.
“They said we must pay N30,000 before they would attend to her,” her sister, Zuwaira Ibrahim recounted, adding: “We only had N5,000; my husband promised to pay the rest in the morning, but they refused. We begged them for one hour while Fatimah writhed in pain.”
The hospital staff insisted on no payment, no treatment.
Feeling helpless and desperate, they rushed her to a traditional birth attendant. There, in a small, dimly lit room, the birth attendant did what she could. Fatimah gave birth, but the baby was already dead.
Fatimah often sat quietly at her sister’s doorstep, staring into the distance, her hands resting on her belly where life once stirred. She is of one of many women in rural Niger communities who rely on traditional birth attendants during labour due to factors like poor access to primary healthcare, long distances to hospitals, high costs, and deep mistrust of public health facilities.
TBAs in Northern Nigeria
In Northern Nigeria, especially in rural and underserved areas, traditional birth attendants (TBAs) remain a critical part of maternal healthcare. With poor access to functional primary health centres, insecurity, poverty, and crumbling infrastructure, many women continue to rely on TBAs during pregnancy and childbirth.
Often older women respected within their communities, TBAs provide assistance using experience passed down through generations, local herbs, and spiritual care. They step in where the formal health system fails.
Ideally, primary health centres should be the first point of contact for pregnancy care. But in many rural communities, these facilities are either non-existent or barely functional. Some have no staff on duty, lack essential equipment, or operate without electricity or clean water.
TBAs speak
Eighty two -year-old Bayi Yakubu is one of the traditional birth attendants (TBA) mostly patronised by the locals in the Ibeto community.
She inherited the skill from her mother before marriage. Though initially reluctant, she now finds pride and fulfilment in the work that has become her lifelong calling.
“I didn’t want to be a traditional birth attendant at first. My parents forced me into it, even beating me when I refused. But today, I’m grateful because I’ve helped many women, and I’m proud of what I do,” she said.
When The ICIR visited her home in May, she had just finished delivering a baby in the community.
Bayi uses traditional herbs, such as Janyaro( Guinea corn leaf or sorghum leaf) and Ganyen Maje (Neem leaf), which she boils and gives to women in labour to ease the delivery process or help them recover afterwards. On average, she attends to about ten pregnant women a month.
Beyond delivering babies, Yakubu says her work prioritises privacy and compassion—two things many women say they no longer receive at public hospitals.
“Women prefer us because we keep things private and take care of them better than the hospitals. We understand their pain,” she said.
She acknowledges that some cases are beyond her expertise, especially when complications like obstructed labour require surgical intervention.
“If a woman is suffering too much or I suspect she may need an operation, I send her to the hospital. I don’t take chances,” she explained, adding: “By God’s grace, I’ve never lost a mother or baby under my care.”
Fifty eight-year-old Aisha Mohammadu is one of the trusted figures for expectant mothers in her community, Usalle. A mother of 12 herself, Aisha combines farming with her role as a traditional birth attendant (TBA), which she inherited from her grandmother.
“I learned this work before I got married,” she told The ICIR, seated in the courtyard of her mud home. “I didn’t go to school for it. I was trained by my grandmother, who helped many women before me.”
Aisha assists more than five women each month, relying solely on traditional herbs.
“We don’t charge much, and we also protect their secrets. At the hospital, male doctors sometimes attend to women in labour. Here, it’s always woman to woman.”
Despite having no formal training or access to modern equipment, Aisha insists she has never experienced the loss of a mother or child under her care. But she admits that in difficult cases, she knows her limits.
“If labour becomes too risky, I try my traditional medicine. If it doesn’t work, I’ll send the woman to the hospital,” she said.
While TBAs like Aisha and Bayi are deeply rooted in their communities, the maternal health data tells a different story.
The National Demographic Health Survey(2023-2024) revealed that the percentage of live births attended by skilled providers in Nigeria was just 46 per cent, showing that over half of all births in Nigeria are still not assisted by trained health professionals.
Studies have shown that most TBAs engage in trial and error and do not have defined guidelines that determine when they cannot manage a complication, and this may lead to late referral with fatal consequences.
In 2020, a consortium consisting of Africare, an international NGO focused exclusively on Africa, EpiAFRIC, an African health consultancy group, and the Nigeria Health Watch, an NGO with a focus on strengthening the capacity of health sector organisations in Nigeria, carried out an 18-month project called ‘Giving Birth In Nigeria’.
The report focused on shining a light on the high prevalence of maternal deaths in various communities. During the review period, 133 maternal deaths were documented in 18 communities in the six states.
The result showed that out of the 133 maternal deaths, only 17 occurred in a designated health facility, signalling the high density of unaccounted mothers dying during childbirth. About 52 deaths took place at home, and 56 deaths occurred in the homes of TBAs.
Why pregnant women prefer TBAs
Residents of various communities in Niger State who spoke with The ICIR said they choose traditional birth attendants because it’s a more affordable, accessible and familiar alternative.
They also cited infrastructure decay and lack of medical supplies in their neighbouring hospitals. The women said they feel safe in the hands of traditional birth attendants who are always women, unlike neighbouring hospitals where female health workers may not be available.
Suwaiba Alhasan, a 43-year-old mother of eight from Usalle community in Kontagora Local Government Area, said she often finds it difficult to access healthcare during pregnancy.
For Suwaiba, the choice to use a TBA is not just about distance and cost; it is also about dignity and care.
She said many women prefer TBAs because they offer privacy and personal attention. Unlike hospitals, where patients may feel neglected, TBAs attend to women in their homes, sometimes helping with laundry and newborn care after delivery.
“While pregnant, I always worry about how I will manage because the hospital is far from our community. I needed to go for a scan every month, which means I must pay for transportation to travel almost 7 kilometres. Sometimes, we don’t even have money to pay for the scan. Even when we reach the hospital, the nurses and doctors often do not attend to us properly.”
She also noted that TBAs are flexible with payments and are willing to help even when families cannot afford hospital bills.
Despite recognising the risks, women like Suwaiba say they feel more comfortable and respected with TBAs. But she also expressed concern about the limitations TBAs face—many do not have modern medical tools, scanning machines, or sterile equipment.
She explained that the nearest hospital is about seven kilometres away and requires a motorcycle to reach. Even when she gets there, she says the facility is poorly equipped and the staff are sometimes unavailable or inattentive.
The ICIR visited the primary healthcare centre (PHC) in her locality, Tadali PHC, but it was found closed. Residents said there are only two male health workers available to attend to patients, which is why many women do not feel safe going to the hospital. The facility also suffers from a leaking roof, insufficient medical supplies, and poor infrastructure.
In Tungan Maje village, located in Magama Local Government Area of Niger State, 35-year-old Safiya Umar had given birth nine times, but only three of them were born in the hospital. The rest were through traditional birth attendants.
“The last time I visited the hospital was four months ago, when I found out I was pregnant again,” Safiya recalled, adding that she was turned away.
“When I got to the hospital, only male staff were around. I asked for the nurses, but they said the two female staff were not available that day. So I left without receiving treatment and returned the next morning when the nurses were there.”
For women in Safiya’s village, access to healthcare is a journey. There is no hospital within the community. The nearest facility is about two hours away and requires transportation by motorcycle. “We cannot walk that far,” she said. “If your husband does not have a motorcycle or money for transport, you may have no choice but to stay home.”
“Even when women manage to reach the hospital, they face additional barriers. The hospital is not good,” Safiya said,adding: “It is not well equipped, there is no electricity, no water, and the doctors and nurses do not treat us well.”
Because of this, many women in her community turn to traditional birth attendants. Safiya says they treat them better.
“For me, I go to the traditional attendants because they treat us with respect and do not demand money from us. Even if you do not have anything, she will still help, and you can pay her later,” Safiya said.
But trust alone cannot replace medical support.
Safiya shared a painful experience involving her husband’s junior wife. One night around 10 p.m., the woman went into labour. In a panic, they rushed her to the hospital at Ibeto ward, only to find the facility closed.
As the labour pains grew worse, Safiya stood by, feeling helpless. With no other option, they took her to a traditional birth attendant around midnight. The attendant did all she could, and the woman eventually gave birth. But by then, the baby had died. The mother, who had been sick for nearly a month, barely survived.
Nigeria is the world’s most dangerous nation in which to give birth. According to the most recent UN estimates for the country, compiled from 2023 figures, one in 100 Nigerian women die in labour or the following days.
The country, alongside other UN member states, in 2001 agreed to the Millennium Development Goals (MDGs), which included a call for the number of maternal deaths to be cut by three-quarters by 2015. Later, Nigeria transitioned to the Sustainable Development Goals (SDGs), which now aim to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. Yet, the country continues to record some of the highest maternal death rates in the world.
According to the 2023–24 Nigeria Demographic and Health Survey (NDHS), Nigeria continues to face alarming rates of maternal and child mortality. The under-five mortality rate stands at 110 deaths per 1,000 live births, meaning 1 in every 9 children dies before their fifth birthday. The infant mortality rate (death under one year of age) is 63 per 1,000 live births, while neonatal mortality( death within first 28 days of life) is 41 per 1,000 live births. In Niger State, the under-five mortality rate is still high at 49 deaths per 1,000 live births, while neonatal mortality is 22 deaths per 1000 live births.
These figures fall far short of the Sustainable Development Goal (SDG) targets, which aim to reduce neonatal mortality to at least 12 per 1,000 live births and under-five mortality to as low as 25 per 1,000 live births. Similarly, maternal mortality is still unacceptably high, with Nigeria recording 512 deaths per 100,000 live births, far above the SDG target.
According to the report, lack of access to quality health care, lack of skilled health workers, education and poverty are some of the structural factors that have contributed to maternity and infant mortality rates in Nigeria especially in rural areas, leaving women and children at higher risk of exposure to dangerous delivery practices that contribute to high mortality.
TBA and rural maternal healthcare in Niger
In recent years, Niger State has undertaken various initiatives to improve rural healthcare delivery. The state government allocated about 70 per cent of the 2025 budget to these sectors.
In addition to financial allocations, the state government is implementing various initiatives to improve healthcare delivery. In May 2025, the Niger state government led by Governor Bago commissioned 20 newly constructed level 2 primary healthcare centres across 16 Local Government Areas (LGAs).
However, significant challenges remain in achieving effective healthcare delivery in the state. The ICIR reported that the state’s heavy reliance on federal allocations and the need to improve internally generated revenue are key factors that could affect the successful implementation of these initiatives.
Photo credit: Niger State Government
The ICIR previously reported that despite interventions such as the Federal Government’s Basic Health Care Provision Fund (BHCPF), many primary healthcare centres, particularly in rural areas, continue to face serious issues, including inadequate staffing, a shortage of essential drugs, and poor infrastructure.
Cultural and religious norms also hinder access to healthcare. In many communities, women require their husbands’ permission to visit health facilities, leading to delays in seeking medical attention. Such societal constraints undermine the effectiveness of programmes which aim to improve maternal and child healthcare.
The ICIR contacted Fatimah Muhammad, the Public Relations Officer of Niger State Primary Healthcare Development Agency on what the agency is doing to address the gaps in healthcare delivery. She asked this reporter to send his enquiries via email, but no response has been received as of the time of filing this report.
Experts advocate for integration
In an interview with The ICIR, Technical Officer at the Centre for Communication and Reproductive Health Services (CCRHS), Shehu Ahmed Baba, warned against the continued practice of untrained Traditional Birth Attendants (TBAs) conducting deliveries without medical supervision or access to sterile equipment, saying it poses a significant risk to maternal and neonatal health.
“It is not safe for TBAs to continue conducting deliveries without medical training or access to sterile equipment, as this will further increase cases of MNCH (Maternal, Neonatal and Child Health) complications,” Baba said.
According to him, this, in the long run, will increase the burden on healthcare workers across facilities and also drive up the indices of maternal and neonatal deaths.
He called on the government to strengthen health facilities to meet the required Minimum Service Package (MSP) standards and improve the capacity of healthcare workers for effective service delivery.
He said while TBAs continue to play a vital role in service provision, especially in hard-to-reach communities, their skills must be enhanced through formal training and integration into the broader healthcare system.
“TBAs should be trained to deliver effective services and linked to health facilities for referral services in cases of complications. The Task-Shifting and Task-Sharing (TSTS) policy should be enforced and strengthened,” he added.
On his part, a Health Policy Officer at African Region for Society for Family Health, Yusuf Hassan Wada, pointed out that the safety of deliveries conducted by traditional birth attendants (TBAs) without formal medical training or access to sterile equipment remains a major concern, especially in the context of maternal and new born health.
He explained that despite the Federal Ministry of Health not formally endorsing TBAs, they continue to play a significant role, particularly in rural and underserved areas of Nigeria.
“Evidence consistently shows that maternal and neonatal outcomes improve significantly when deliveries are handled by skilled birth attendants,” he said, adding: “However, in areas where access to health professionals is limited, TBAs have stepped in to fill a critical gap.”
According to him, many TBAs are no longer the “untrained individuals of the past,” as some states have introduced training programmes to build their capacity in basic hygiene, referral systems, and danger sign recognition.
“For example, trained TBAs are now more likely to refer women to facilities earlier and use protective equipment like gloves during delivery, which reduces the risk of infection,” Wada added.
Still, he warned that “home deliveries often still occur in unsanitary environments, exposing mothers, new-borns, and even the TBAs themselves to infections.”
He said continued efforts were needed to strengthen primary healthcare and regulate TBA practice through structures such as Traditional Medicine Boards.
Asked what the government could do in places like Niger State, where many women depend heavily on TBAs due to failing health systems, Wada described the situation as “a very real and urgent challenge.”
He called for investments in PHC infrastructure and staffing, mobile health outreach, and community-based insurance to lower cost barriers.
Wada also recommended involving the Traditional Medicine Board, noting that in other states, licencing and monitoring TBAs have improved safety and referrals.
“Ultimately, solving this issue requires treating the root causes, not just the symptoms and that begins with strengthening trust, access, and quality in the public health system,” he said.
Nurudeen Akewushola is an investigative reporter and fact-checker with The ICIR. He believes courageous in-depth investigative reporting is the key to social justice, accountability and good governance in society. You can reach him via nyahaya@icirnigeria.org and @NurudeenAkewus1 on Twitter.