West Africa still has the highest under-five mortality rate in the world, at 92 deaths per 1,000 live births according to the figures gathered in RFLD’s manual on promoting maternal and child health rights in West Africa. Behind that regional average, the picture changes sharply from one country to the next.
The manual reviews national laws, health policies and the latest available data country by country, using ministry reports, WHO and UNFPA sources and Demographic and Health Surveys. Here is what stands out.
Where progress is measurable
Senegal reports a maternal mortality ratio of about 260.9 deaths per 100,000 live births in 2023, around 30 per cent lower than in 2010. Skilled attendants now assist 92 per cent of births, compared with about 60 per cent a decade earlier. The share of women with at least four antenatal visits rose from 56 per cent in 2019 to 68 per cent in 2023, and neonatal mortality fell from 35 to 23 per 1,000.
Mali shows similar movement on child survival. Under-five mortality fell from 132 per 1,000 in 2010 to 2014 to 87 per 1,000 in 2023 to 2024, and infant mortality from 65 to 52, according to the seventh Demographic and Health Survey. Malnutrition remains the weak point: 38 per cent of children under five are stunted.
Where the trend is going the wrong way
In Sierra Leone, neonatal mortality rose from 28 per 1,000 in 2020 to 31 in 2025. About half of births still take place without qualified help, and only 40 per cent of mothers receive postnatal care. In Guinea, infant mortality fell from 63.4 per 1,000 in 2019 to 58.1 in 2022, then rose to 67 in 2024 according to official statements.
Nigeria carries the heaviest weight. With 512 maternal deaths per 100,000 live births (WHO, 2020), the country accounted for 28.5 per cent of maternal deaths worldwide in the UN estimates published in 2023.
National averages hide the gaps
In Benin, 87 per cent of births take place in a health facility at national level. In Borgou the figure is 62.1 per cent. The manual finds the same pattern across the region: rural women, women in conflict-affected areas and women who cannot pay informal fees are the ones left behind. Northern Côte d’Ivoire, North-East Nigeria and Burkina Faso record worse indicators than the rest of their countries.
The causes are well known. Haemorrhage, infection and hypertensive disorders kill mothers. Neonatal infections, prematurity, malaria, diarrhoea and malnutrition kill children. Most of these deaths can be prevented with skilled care, medicines and a working referral system.
What free care has already changed
Several governments have shown that policy choices matter. Niger made caesarean sections free in 2005, then contraceptives and antenatal care free in 2006. Sierra Leone launched its Free Healthcare Initiative in 2010. Guinea offers free care to pregnant women and children under five. The manual notes that these measures reduced some deaths, but that enforcement is uneven and informal payments still keep many women away from clinics.
A right, written in the Maputo Protocol
Article 14 of the Maputo Protocol guarantees women’s right to health, including sexual and reproductive health, and requires States to provide adequate, affordable and accessible health services. Maternal death is therefore a question of rights as well as of medicine. When a woman dies because the nearest clinic has no midwife, the State has an obligation it has not met.
The manual calls for better health infrastructure, more qualified staff in rural areas, community awareness and universal health coverage that removes financial and geographic barriers. RFLD’s Midwives to Leaders training in Benin is one way we are putting that evidence to work.
Read the full manual
The full manual (in French) includes the laws, policies and data for each country. Learn more about our maternal, newborn and child health work and browse our publications. Figures are those reported in the manual from national and international sources; corrections are welcome at programs@rflgd.org.
