Predictors of Maternal Mortality in Nigeria: Public Health Policy and Practice

Introduction: Maternal mortality remains a major public health crisis in Nigeria, which contributes approximately 20% of global maternal deaths. Despite various national interventions, the maternal mortality ratio (MMR) remains alarmingly high at 512 per 100,000 live births. This study aims to investigate the multifactorial predictors of maternal mortality and evaluate the effectiveness of public health interventions while benchmarking Nigeria's progress against regional and global standards. Method A mixed-methods approach was employed, combining secondary data analysis, policy document review, and thematic coding. Quantitative data were drawn from the 2018 Nigeria Demographic and Health Survey (NDHS), WHO Global Health Observatory, and World Bank datasets. Analytical methods included logistic regression, multilevel modeling, and predictive margins analysis. Qualitative data were sourced from national health policy reports and analyzed using NVivo software. Policy effectiveness was assessed through content analysis, SWOT evaluation, and Delphi-informed synthesis. Result Key predictors of maternal mortality include low maternal education (AOR = 2.34), poverty (AOR = 1.96), rural residence (AOR = 1.42), early childbirth (< 18 years, AOR = 1.58), high parity (AOR = 1.73), and absence of skilled birth attendants (AOR = 2.89). Policies like SOML-PforR demonstrated moderate-to-high effectiveness, while NHIS and MSS were limited by weak implementation. Barriers such as financial constraints (42%), cultural norms (25%), geographic isolation (23%), and poor infrastructure (10%) were prevalent. Nigeria’s MMR trajectory remains off-track for SDG 3.1, especially when compared to countries like Ethiopia and Rwanda. Conclusion Maternal mortality in Nigeria is driven by predictable, modifiable socioeconomic and systemic factors. While some public health initiatives have made modest progress, overall policy impact is undermined by poor implementation, fragmented health systems, and socio-cultural barriers. The study advocates for integrated reforms in primary health care, health financing, workforce incentives, and community engagement. A data-driven, equity-focused strategy is essential to meaningfully reduce maternal deaths and meet global development targets.