The Pregnancy Paradox: How Nigeria's IVF Boom Can Improve Maternal Outcomes

According to the WHO, roughly 20% of all global maternal deaths occur in Nigeria, with a maternal mortality rate of over 1,000 per 100,000 live births. Nigerian women have a 1 in 22 lifetime risk of dying during pregnancy, childbirth, or postpartum; in most developed countries, the risk is 1 in 4,900.

At the same time, Nigeria is becoming a hub for in-vitro fertilisation (IVF) and fertility care, even attracting women from the diaspora. This paradox of a booming fertility industry amidst the backdrop of alarming maternal outcomes begs the question of what can be learned from Nigeria’s IVF/fertility care space to improve the outcomes for mothers across the country and continent?

Today, there are around 100 fertility clinics in Nigeria across all major regions and states, representing an over 4,000% increase since the first IVF clinic was set up over 2 decades ago. 

The primary reason that women from the diaspora travel back to countries like Nigeria for fertility care is the lower cost. The cost of a single IVF treatment cycle in Nigeria ranges from USD $3,700 to $5,400, though couples usually need at least 2-3 cycles.

In comparison, in the US, the cost of IVF can range from $12,000-$14,000 for one cycle. In Canada, it can range from $10,000 to $15,000 per cycle. In the UK, according to the NHS, private IVF care can be up to £5,000 or higher (USD $6,300), and while the NHS provides IVF care, the criteria for who qualifies for NHS-covered IVF care can be very strict and vary across regions.

Ghana, Nigeria, Egypt and South Africa have the highest number of registered IVF clinics in Africa. The cost of IVF can range from USD $4,600 to $6,000 per cycle in Ghana, USD $5,000-$6,500 or higher in Egypt, and USD $3,700-$4,200 per cycle in South Africa. These numbers are similar to Nigeria, pointing to a potential continent-wide phenomenon creating an attractive market for IVF care.

Another curious paradox is that amidst the backdrop of the brain drain causing thousands of doctors across the country and the continent to flee to western nations, there has been an influx of doctors coming into the country to set up fertility clinics. After Dr Richard Ajayi came from the UK to set up the country’s first IVF clinic in 1999, other doctors followed suit, setting up clinics that allowed the IVF and fertility care space to flourish in Nigeria.

These clinics have attracted couples from all over the country and the diaspora seeking treatment, coining the term “fertility tourism”.  Beyond the reduced costs compared to the US, UK, Canada and other western countries, other factors for the influx of couples seeking fertility care include the ease of sourcing donor material and surrogates given similar ethnic and racial profiles, the success rates of treatments, and the highly restrictive insurance coverage criteria of IVF and fertility care in western countries. 

Recent legislation has made it even harder to access fertility care in major western countries, potentially leading to an uptick in fertility tourism in Africa. For example, the 2024 Alabama state ruling that embryos created through IVF should be considered children brought IVF care across the state to a standstill, causing couples to explore fertility care in other states and even other countries.

While the success of the fertility and IVF industry in Nigeria is noteworthy, it is hard to ignore the backdrop of wider poor maternal outcomes across the country. There is inequality in access to fertility and maternal care as well as insufficient primary care for mothers and babies in the country.  UNICEF data revealed that skilled health personnel attended to just under half (49 per cent) of all deliveries that took place in Nigeria, with rural areas seeing only 37 per cent of deliveries attended by skilled health personnel; in the rest of the world, skilled health personnel attended over two thirds of deliveries. 

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The high rate of child marriages and low women and girls' education rates in some parts of the country keep maternal health outcomes poor as women are more likely to experience unintended pregnancies and have reduced access to maternal healthcare. Nigeria has the third highest confirmed number of child brides globally (over 3.5 million) and in Nigeria, 3 in every 10 women aged 20-24 years have given birth before the age of 18.

So what can we learn from the booming IVF industry in Nigeria and how can we leverage those takeaways to improve maternal healthcare for all women across the country? 

While there is a lot of stigma around infertility and reproductive care in Nigerian and other African cultures, the increased popularity and awareness of IVF could have a positive spillover effect into maternal healthcare in general, leading more women to seek appropriate care. Data from fertility clinics on pregnancy, childbirth and postpartum outcomes could be leveraged to understand key trends among Nigerian women that can allow for tailored policies and the creation of region-specific maternity care guidelines. Lastly, fertility specialists that see a high volume of patients could share their skills and expertise, teaching and training and sharing best practices with skilled healthcare personnel working in the maternal care space. 

Key Takeaways from TC Health: The coexistence of Nigeria's booming IVF industry alongside alarming maternal mortality rates is a complex juxtaposition that demands attention. While the nation has witnessed a remarkable surge in fertility clinics, offering hope to many seeking affordable care, it's crucial to acknowledge the persistent challenges in maternal healthcare accessibility and outcomes more broadly. However, amidst these disparities lies an opportunity for transformative change. Leveraging insights from the IVF sector could inform comprehensive maternal health strategies, from tailored policies to improved healthcare delivery. Moreover, fostering collaboration between fertility specialists and maternal care providers can facilitate knowledge exchange and skill-sharing, ultimately driving progress towards equitable and effective maternal healthcare for all Nigerian women.