Why Nigeria must prioritise maternal mental health

At the heart of each society is a mother—bearing life, giving rise to generations, and holding families together. Yet, even though she is an icon of endurance, courage and self-denial, there is a quiet disease that creeps into her heart, behind closed doors, behind concealed smiles, and behind the sacred duty of motherhood. That illness […]

At the heart of each society is a mother—bearing life, giving rise to generations, and holding families together. Yet, even though she is an icon of endurance, courage and self-denial, there is a quiet disease that creeps into her heart, behind closed doors, behind concealed smiles, and behind the sacred duty of motherhood. That illness is maternal mental health disorder—an illness so pervasive and destructive, but so unreported, that it has become a silent killer that ironically injures the foundation of our society.

Maternal mental health in Nigeria today is not just a public health problem—it is a public silence. While the world might associate maternal health with physical conditions like haemorrhage, sepsis, or eclampsia, emotional and psychological pain experienced by many mothers remains veiled in stigma and cultural denial.

Mental illness, particularly during and after pregnancy, is often considered a “spiritual problem,” a test of faith, or worse, a woman’s weakness. Consequently, a vast majority of Nigerian mothers are battling depression, anxiety and even suicidal tendencies in complete secrecy.

According to the World Health Organisation, about 10 per cent of pregnant women and 13 per cent of postpartum women globally suffer from mental disorders, mostly depression. In lower- and middle-income countries, the figure is higher—going up to as much as 20 per cent in some settings. Nigeria, however, tells an even more dismal story.

Research has shown that as many as 25 per cent of Nigerian women go through perinatal depression, and postpartum depression affects as many as 19 per cent. Another recent study estimated that pregnancy-related anxiety is experienced by over 43 per cent of pregnant women in the country. These are not just statistics—they are the invisible faces of thousands of women in villages, towns, and cities, quietly suffering, frequently alone and despairing.

The implications are profound. Maternal mental disorders do not just affect the mothers. Infants of depressed mothers are also at higher risk of low birth weight, malnutrition, and developmental delay. Breastfeeding is significantly decreased, immunisation schedules are often missed, and the all-important mother-child relationship is compromised.

Furthermore, maternal suicide, although largely underreported in Nigeria, has been recognised globally as one of the leading causes of postnatal death in mothers. Not only are we losing mothers to infection and haemorrhage but also to hopelessness, loneliness, and untreated psychological distress.

The reasons for this gap are several. First, stigma related to mental illness remains widely entrenched in Nigeria. A depressed new mother is more likely to be labeled ungrateful or unspiritual than treated. New mothers are supposed to snap out of it immediately, care for the baby flawlessly, and carry out household chores without a murmur of complaint.

In communities where spirituality is more likely to be preferred over medical explanation, most women are taken to prayer houses instead of clinics. As such, their pain becomes spiritualised rather than medicalised—further entrenching denial and delay in treatment.

Secondly, the healthcare system in Nigeria is not well-equipped to deal with maternal mental health in a successful way. Antenatal care is tailored predominantly to physical well-being, with little or no attention to emotional health. Most health workers, especially at the primary care level, have not received training in perinatal depression or anxiety detection and management.

Mental health care continues to be centralised in urban tertiary hospitals and is often inaccessible or unaffordable to rural and poor women. Nigeria has fewer than 300 psychiatrists for a population of over 200 million; even fewer practice perinatal psychiatry. The shortage is enormous, and women are slipping through the cracks.

Despite this bleak picture, there are grounds for optimism. The passing of Nigeria’s Mental Health Act in 2023 is a step in the right direction. The act will integrate mental health into primary healthcare, reduce stigma, and protect the rights of persons with mental disorders.  Though long-awaited, the Act opens up a window of opportunity for the mainstreaming of maternal mental health into national health plans. The laws themselves, however, do not implement themselves. The main work is in implementing the policy—training health workers, equipping primary health centres, and adding mental health screening to antenatal and postnatal packages.

Some commendable grassroots efforts also exist. The MamaCare360 programme of the Wellbeing Foundation Africa has been showing promising results. By training mothers and with its referral system grounded in emotional and physical risk factors, the programme provides a model that can be scaled up across states. Similarly, the Lagos State Maternal Mental Health Project is beginning to integrate mental health into maternal care, increasing health literacy, and building community-based care.

Yet more needs to be done. I don’t think it will be dramatic if Nigeria declares maternal mental health a national emergency. The Federal Ministry of Health should mandate the delivery of routine mental health screening during all antenatal and postnatal visits.

All healthcare providers, including physicians and midwives, must be trained to identify signs of maternal distress and offer basic minimum interventions or referrals. Primary health centres should have at least one mental health focal person, trained in perinatal emotional care, with the ability to provide counseling or refer patients to appropriate services.

Besides, there is an urgent need for public sensitisation campaigns. Safe spaces—both social and physical—need to be created where mothers can discuss their mental illness without fear of judgment. Religious and cultural leaders need to be engaged to counter the cultural myths and misconceptions regarding maternal mental illness. Spiritual and modern medicine must be working with and not against one another, so a system is created where prayer and psychological therapy stand together for the benefit of women.

And so, we stand here—a country where women carry life and pain in the same breath, where mothers smile through invisible scars because no one told them that healing has a mind. We have closed our eyes for too long. We’ve wrapped sorrow in silence and labeled it strength. We’ve mistaken survival for wellness.

But the truth is, when a mother’s mind breaks, something in society breaks with her. When we ignore her pain, we are jeopardising the future that she is trying to nurture. We cannot speak of ending maternal mortality if we ignore the sorrows that can drive a woman to take her own life. We cannot boast of improving maternal health while mental health is an afterthought—at best.

Yes, there are written policies and pilot projects in patches. But Nigeria is past the pilot stage. What we now require is political will, bold investment, and cultural unlearning. Maternal mental health is not something abstract; it’s a woman who has not slept in days, a new mother who will not stop crying. These are not statistics. They are citizens.

If we do nothing, the silence will keep on healing nothing—and hurting all. So let us begin to listen, out loud. Let us utter the pain. Let us build systems in which women can bring both their babies and their burdens and find healing for both.