By Adeyinka Joseph Alonge.
Maternal mortality remains one of Nigeria’s most serious public-health challenges.
Many pregnancy-related deaths are preventable when women receive timely antenatal care, skilled support during childbirth, emergency treatment when complications occur and appropriate follow-up after delivery. Yet access to these services is shaped by more than the availability of a clinic.
What families know, believe and decide can determine whether a pregnant woman seeks care early or arrives only after a complication has become severe.
That is why community health education matters.
Nigeria is currently strengthening maternal and newborn health through primary healthcare reforms, midwifery development, community-health-worker deployment and the Maternal Mortality Reduction Innovation Initiative, commonly called MAMII. The Federal Ministry of Health and Social Welfare has also emphasised deeper community engagement and skilled birth attendance as part of its maternal-health strategy.
However, health education will not reduce maternal deaths simply because information has been delivered. The message must be understandable, culturally appropriate, practical and connected to services that women can actually use.
Based on current maternal-health guidance and lessons from culturally tailored health-education research, the following seven strategies can help communities improve maternal-health knowledge and encourage timely care.
1. Teach Pregnancy Danger Signs in Simple, Local Language
A woman and her family need to recognise when a pregnancy symptom requires urgent medical attention.
Community health education should explain important warning signs such as:
Heavy vaginal bleeding
Severe headache
Blurred vision
Convulsions
Severe abdominal pain
Difficulty breathing
Swelling of the face or hands
High fever
Loss of consciousness
Labour lasting unusually long
Reduced or absent movement of the baby
Heavy bleeding after childbirth
These messages should not be buried inside a long lecture filled with medical terminology.
A health worker can explain:
“If she is bleeding heavily, having convulsions, struggling to breathe or becoming unconscious, do not wait at home. Take her to a health facility immediately.”
The wording should be translated into the language people use in everyday conversation. Where literacy is limited, pictures, demonstrations, storytelling and repeated verbal communication can be more useful than printed leaflets.
Health educators should also explain that some dangerous complications develop without obvious pain. High blood pressure in pregnancy, for example, may be discovered during antenatal checks before the woman realises that anything is wrong.
Protein in the urine may sometimes be associated with pre-eclampsia, although it can also have other causes. Readers can learn more from this introduction to protein in the urine, its possible causes and why medical assessment matters.
Nigeria’s Safe Motherhood priorities identify postpartum haemorrhage and hypertensive disorders such as pre-eclampsia and eclampsia among the major complications requiring stronger prevention and public awareness.
Why this strategy works
People are more likely to seek help when they can recognise a problem and understand that delay may be dangerous.
Simply telling women to “go to the hospital when necessary” is not enough. They need to know what “necessary” looks like.
2. Involve Husbands, Partners and Other Family Decision-Makers
Pregnancy is experienced by the woman, but decisions about healthcare may involve several people.
In some households, a husband controls transport money. In others, a mother-in-law, older relative or community leader influences where the woman delivers. A pregnant woman may understand the need for care but still be unable to act quickly without family support.
Community health education should therefore include:
Husbands and partners
Mothers-in-law
Fathers and older relatives
Traditional and religious leaders
Community development groups
Men’s associations
Women’s groups
Men should be encouraged to participate in birth preparedness without taking control away from the pregnant woman.
Practical responsibilities can include:
Saving money for antenatal care and delivery
Arranging transport
Identifying a suitable health facility
Knowing important emergency telephone numbers
Supporting attendance at appointments
Helping with household responsibilities
Recognising danger signs
Supporting decisions made by qualified health professionals
The goal is not to suggest that women need permission to receive healthcare. The aim is to address the reality that household decision-making and financial control can affect how quickly care is obtained.
Why this strategy works
A woman is less likely to face dangerous delays when the people around her already understand the plan and agree that emergency care should not be postponed.
3. Use Trusted Community Voices, Not Health Workers Alone
People do not automatically accept a message because it comes from a professional.
Health workers may understand the clinical facts, but community members may place greater trust in religious leaders, traditional leaders, respected older women, birth companions, women’s-group leaders or people who have experienced pregnancy complications.
Community education can be strengthened when health professionals work with trusted local voices.
This may involve:
Training religious leaders to share accurate maternal-health messages
Including maternal-health discussions in women’s meetings
Engaging traditional leaders in emergency-transport planning
Using respected mothers as peer educators
Working with traditional birth attendants as referral partners where appropriate
Organising community dialogues rather than one-way lectures
Using local radio presenters who understand the community
UNICEF’s communication approaches in Nigeria have used community dialogue, peer counselling, theatre, listening groups, interpersonal communication and other interactive platforms to support maternal, newborn and child health.
Trusted messengers must still receive accurate training. Popularity does not replace medical knowledge.
Why this strategy works
People are more likely to listen when the information comes through someone they already know, provided the message remains medically accurate.
4. Replace General Advice With a Personal Birth-Preparedness Plan
Pregnant women are often told to attend antenatal care and deliver at a health facility. That advice is important, but it remains incomplete until it is converted into a practical plan.
Every pregnant woman should be encouraged to answer questions such as:
Where will I receive antenatal care?
Where do I plan to give birth?
How will I get there?
Who will accompany me?
How much money should we prepare?
What will happen if labour begins at night?
Which alternative facility can manage an emergency?
Who can donate blood if it is required?
Who will care for my other children?
Which items should I prepare before the expected delivery date?
Community health workers can use a simple checklist during household visits, antenatal sessions or group meetings.
The plan should be reviewed throughout pregnancy because circumstances can change.
A family may initially plan to use a nearby facility, only to discover that it lacks round-the-clock delivery services, blood transfusion capacity or the ability to perform emergency surgery. Community health workers should know local referral pathways and avoid giving false reassurance about services that are not available.
Why this strategy works
Knowledge becomes more useful when it leads to a specific decision.
A family that has already identified transport, money and a facility can respond more quickly than one trying to make every decision during an emergency.
5. Address Beliefs and Misconceptions Respectfully
Health education often fails when professionals dismiss cultural beliefs without first understanding them.
Communities may hold beliefs about:
The appropriate time to announce a pregnancy
Foods a pregnant woman should avoid
Whether antenatal medicines make babies too large
Whether childbirth complications are spiritual
Where a woman should deliver
Whether a first pregnancy requires medical supervision
Whether convulsions during pregnancy can be treated at home
Whether caesarean delivery represents failure
Whether heavy bleeding after childbirth is normal
Some beliefs may be harmless. Others may contribute to malnutrition, delayed care or refusal of effective treatment.
A culturally tailored approach does not mean accepting harmful practices. It means understanding the local explanation, identifying the concern behind it and responding in a way that respects the person while correcting misinformation.
For example, instead of saying:
“That belief is wrong.”
A health educator could say:
“Many families have heard that. Let us explain what happens medically and why the clinic recommends this treatment.”
In my research work on culturally tailored health education, one recurring lesson is that information is more likely to influence behaviour when it reflects the audience’s language, beliefs, social relationships and practical realities.
A technically correct message can still fail when people do not recognise themselves or their circumstances in it.
Why this strategy works
Respectful discussion reduces defensiveness and creates room for people to compare existing beliefs with clear medical explanations.
6. Combine Education With Referrals, Follow-Up and Problem-Solving
Health education should not end with “please go to the clinic.”
A woman may understand the message but still face:
Transport costs
Distance
Poor roads
Fear of disrespectful treatment
Previous negative experiences
Lack of childcare
Inability to leave work
Uncertainty about service costs
Language barriers
Long waiting times
Lack of permission or family support
Concern that medicines or supplies will not be available
Community health workers should help families identify realistic solutions.
This may include:
Referring the woman to a specific facility
Giving clear directions and clinic schedules
Confirming when services are available
Following up after a missed antenatal appointment
Connecting the family to community transport arrangements
Helping the woman understand available financial-support programmes
Linking women with peer-support groups
Reporting repeated service barriers to supervisors
Following up after childbirth
Health education is most effective when it is connected to a responsive health system. Encouraging women to seek care will have limited impact if they arrive at a facility and experience disrespect, unavailable staff, missing supplies or unaffordable charges.
WHO guidance emphasises respectful maternal and newborn care, while UNICEF highlights that good outcomes depend on skilled staff, functioning facilities, medicines, supplies and quality services at both health-system and community levels.
Why this strategy works
Information may create intention, but practical support helps turn that intention into action.
7. Repeat Messages Across Pregnancy, Childbirth and the Postnatal Period
One health talk during the first antenatal visit is not enough.
People forget information. New concerns arise. Family members change. Pregnancy risks may develop later, and the period after delivery can also be dangerous.
Education should be repeated through:
Antenatal-care visits
Home visits
Community meetings
Telephone calls or text messages
Local radio
Religious gatherings
Women’s associations
Immunisation and child-health visits
Postnatal appointments
Messages should change according to the stage of pregnancy.
During early pregnancy
Focus on:
Starting antenatal care
Nutrition
Medicines and supplements
Infection prevention
Avoiding harmful substances
Testing and routine screening
Existing health conditions
During later pregnancy
Focus on:
Birth preparedness
Transport
Facility selection
Labour signs
Emergency warning signs
Skilled attendance at delivery
Immediately after childbirth
Focus on:
Heavy bleeding
Fever
Severe headache
Difficulty breathing
Breastfeeding support
Newborn danger signs
Postnatal appointments
Emotional well-being
Family-planning information
WHO stresses that maternal care should continue after delivery because women may still develop serious complications during the postnatal period.
Why this strategy works
Repeated communication improves recall, allows questions to be answered and ensures that information remains relevant as the pregnancy progresses.
What Makes Community Maternal-Health Education Effective?
Good community health education should be:
Accurate
The information must reflect current clinical guidance and national recommendations.
Understandable
Messages should use plain language rather than unexplained medical terms.
Culturally responsive
The approach should recognise local beliefs, languages, family structures and decision-making patterns.
Respectful
Women should not be blamed, threatened or embarrassed.
Practical
Every message should tell the listener what action to take, when to take it and where to seek help.
Inclusive
Husbands, families, adolescents, women with disabilities, displaced populations and people living in remote communities should not be overlooked.
Connected to services
Education should lead to functioning antenatal, delivery, emergency and postnatal services.
Repeated
Important messages should be reinforced through several channels and at different stages.
What Community Health Education Cannot Fix Alone
Community education is essential, but it cannot solve every cause of maternal mortality.
A knowledgeable family may still experience a poor outcome when:
A health facility has no qualified staff
Blood is unavailable
Referral transport is delayed
Essential medicines are out of stock
Emergency surgery cannot be performed
Care is unaffordable
The woman experiences disrespect or neglect
Communication between facilities is weak
Reducing maternal mortality therefore requires both informed communities and functional health services.
Nigeria’s current maternal-health reforms recognise the importance of strengthening primary healthcare, expanding the midwifery workforce, deploying community health workers and targeting high-burden areas.
Community education should create demand for quality care, while the health system must be ready to meet that demand.
Practical Takeaway for Community Health Workers
Community health workers can use the following checklist during maternal-health education:
Ask what the woman and family already believe.
Explain pregnancy danger signs in simple language.
Confirm where the woman attends antenatal care.
Help the family prepare a delivery and emergency plan.
Include the partner or another trusted supporter with the woman’s consent.
Identify barriers such as transport, cost or fear of poor treatment.
Give a specific referral rather than general advice.
Confirm that the family understands what action to take.
Follow up after referral, delivery and during the postnatal period.
Report recurring service problems through the appropriate supervisory channel.
The most important question is not:
“Did I give the health talk?”
It is:
“Can this woman and her family act correctly when they need care?”
Frequently Asked Questions
What is maternal mortality?
Maternal mortality refers to the death of a woman from causes related to or worsened by pregnancy or its management during pregnancy, childbirth or within 42 days after the pregnancy ends.
What are the leading causes of maternal death?
Major causes include severe bleeding, hypertensive disorders, infections, complications of labour and unsafe abortion. Existing health conditions such as anaemia, malaria, diabetes and heart disease can also increase pregnancy risks.
Why do women delay seeking maternity care?
Delays may arise from poor recognition of danger signs, cost, transport difficulties, distance, family decision-making, fear of poor treatment, cultural beliefs and weaknesses in referral services.
Can community health education reduce maternal deaths?
Community education can improve recognition of danger signs, antenatal-care attendance, birth preparedness and timely care-seeking. Its impact is strongest when education is linked to accessible, respectful and properly equipped health services.
Who should receive maternal-health education?
Education should reach pregnant women, partners, families, adolescents, traditional and religious leaders, community groups and anyone who may influence decisions during pregnancy or an emergency.
When should antenatal care begin?
A pregnant woman should contact a qualified healthcare provider early in pregnancy and continue attending the recommended appointments. Early care allows health workers to identify risks, provide preventive services and support birth planning.
Is childbirth at home always safe when previous deliveries were uncomplicated?
No pregnancy or delivery is completely predictable. A previous uncomplicated birth does not guarantee that the next one will be free from complications. Skilled attendance and access to emergency referral remain important.
Final Thoughts
Maternal mortality cannot be reduced through hospital services alone.
Families and communities must understand pregnancy risks, prepare for childbirth and know when urgent care is needed. But education must go beyond distributing information.
The strongest strategies use local language, engage family decision-makers, work through trusted community voices, address beliefs respectfully, create practical birth plans, connect women to services and repeat messages throughout pregnancy and after childbirth.
Community health education works best when women are treated as partners, not passive recipients of instructions.
When accurate knowledge is combined with respectful care, reliable referrals and functional health facilities, more women can survive pregnancy and childbirth and return home safely to their families.
Author: Adeyinka Joseph Alonge is a public health professional, researcher and writer with interests spanning health, science, technology, personal development and practical knowledge for everyday life.
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