Maternal Mortality in Kaduna, Nigeria: A Retrospective Analysis using the Sisterhood Method

Background Nigeria continues to have one of the highest maternal mortality ratios (MMR) globally, with disproportionate risk in the northern states. Kaduna State exemplifies this crisis, where community estimates exceed 1,000 deaths per 100,000 live births. This study assessed maternal mortality using the sisterhood method, supported by health facility data, to examine sociodemographic, reproductive, and clinical predictors of maternal deaths. Methods A retrospective cross-sectional survey was conducted across Kaduna State using the indirect sisterhood method. Adult respondents reported maternal deaths among sisters, supplemented by facility records and staff interviews. Data collected included age, residence, education, pregnancy complications, and contraceptive use. Descriptive statistics, chi-square tests, and multivariate logistic regression were employed to identify predictors of maternal outcomes. Results A total of 596 maternal deaths were recorded. Most occurred among women aged 26–35 years (44.3%) and in rural areas (43.1%). Over 90% of deceased women had no or only basic education. Only 24.2% were using contraception, predominantly short-acting methods. Obstetric hemorrhage (33.9%) and hypertensive disorders (21.5%) were the leading causes of death, followed by complications of obstetric interventions (18.3%). Bivariate analysis indicated significant associations between cause of death and both residence and age (p < 0.001). Contraceptive use was strongly age-dependent, with adolescents (15–20 years) having the lowest likelihood (aOR 0.007; p < 0.001 vs > 45 years). Urban residence was protective against pregnancy complications (aOR 0.55; p = 0.025). No independent predictors were identified for cause-of-death categories. Conclusions Maternal mortality in Kaduna remains unacceptably high, driven largely by preventable complications. The predominance of young, rural, poorly educated, and non-contraceptive-using women underscores systemic gaps in reproductive health services. Expanding access to family planning, especially for adolescents and young women, strengthening rural obstetric care, and improving the quality of facility-based emergency response are critical to reducing maternal deaths and achieving Nigeria’s maternal health targets.