Maternal mortality is one of the major challenges to health systems in sub Saharan Africa. This paper estimates the lifetime risk of maternal death and maternal mortality ratio (MMR) in four states of Northern Nigeria. Data from a household survey conducted in 2011 were utilized by applying the “sisterhood method” for estimating maternal mortality. Female respondents (15–49 years) were interviewed thereby creating a retrospective cohort of their sisters who reached the reproductive age of 15 years. A total of 3,080 respondents reported 7,731 maternal sisters of which 593 were reported dead and 298 of those dead were maternal-related deaths. This corresponded to a lifetime risk of maternal death of 9% (referring to a period about 10.5 years prior to the survey) and an MMR of 1,271 maternal deaths per 100,000 live births; 95% CI was 1,152–1,445 maternal deaths per 100,000 live births. The study calls for improvement of the health system focusing on strategies that will accelerate reduction in MMR such as availability of skilled birth attendants, access to emergency obstetrics care, promotion of facility delivery, availability of antenatal care, and family planning. An accelerated reduction in MMR in the region will contribute towards the attainment of the Millennium Development Goal of maternal mortality reduction in Nigeria. 1. Introduction Maternal mortality is one of the major challenges to health systems in the world and sub Saharan Africa in particular [1]. In order to encourage the international community to address this challenge, maternal mortality reduction was included as one of the Millennium Development Goals, MDG 5. The target of MDG 5 is to reduce maternal mortality ratio (MMR) by 75%, from 1990 to 2015 [2]. Although several studies [3, 4] have highlighted the slow progress in reducing maternal mortality, global reduction in maternal deaths with variations across countries has been reported elsewhere [1]. Global maternal deaths reduced by 35% from 526,300 in 1980 to 342,900 in 2010. In Nigeria, the MMR in 2008 was reported to be 608 deaths per 100,000 live births (95% confidence interval (CI): 372–946). This was an increase from an MMR of 473 (95% CI: 306–703) in 1990 [1]. Despite challenges of measuring maternal mortality, the need for monitoring of maternal mortality is a priority for many countries including Nigeria. Estimates of maternal mortality are indispensable for planning and monitoring the outcomes or impact of interventions. Recently, Nigeria expressed reservations about accuracy and methods used to obtain figures quoted and the
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