Lagos women are increasingly turning to pharmacies, traditional healers, and self-managed care for reproductive health services, according to a rapid assessment by the Women Empowering Women Initiative (WEWIN). The study, which surveyed 154 individuals across Lagos State, found that only 5% of respondents accessed government hospitals, 20% used private clinics, while 45% relied on pharmacies and Patent and Proprietary Medicine Vendors (PPMVs). An additional 30% reported using self-managed or traditional pathways, raising urgent questions about the gaps in Nigeria’s formal healthcare system.
The research, conducted among women of reproductive age, healthcare workers, and community stakeholders, underscores the complex interplay of cost, privacy, and fear of judgment that drives these choices. Stella Peters, Executive Director of WEWIN, noted that younger women expressed concerns about confidentiality, while low-income communities faced pronounced financial barriers. 'A young woman navigating a personal health crisis may find the pharmacy around the corner more accessible than a formal facility where she fears being judged or exposed,' Peters explained.
Despite the reliance on informal providers, the study found that trained PPMVs demonstrated appropriate practices and referral awareness. However, inconsistencies in knowledge and weak referral systems among untrained providers pose risks. 'Pharmacies and PPMVs are often the most accessible healthcare points in Nigerian communities, but their effectiveness depends on standardization and integration with formal care,' Peters said.
The findings highlight a critical disconnect between policy frameworks and on-the-ground realities. Lagos State boasts an extensive healthcare infrastructure, including primary healthcare facilities designed to serve as first points of care. Yet, infrastructure alone cannot build trust. 'Women must feel safe asking difficult questions, confident in confidentiality, and assured of respectful treatment,' Peters emphasized. 'Without these, even the most well-equipped facilities fail to meet their needs.'
Public health experts warn that delayed care due to these barriers can escalate manageable issues into emergencies, ultimately straining formal healthcare resources. 'When women avoid care due to fear or cost, the burden returns to the system, often in more severe forms,' Peters said. 'This underscores the need to re-evaluate how we design and deliver reproductive health services.'
The study calls for a dual approach: strengthening community-level providers through training and referral pathways, while transforming formal facilities into spaces of dignity and trust. 'A responsive health system listens to the signals women send through their choices,' Peters argued. 'If they are opting for alternative routes, it is a sign that our system must evolve to meet their needs.'
WEWIN’s research aligns with broader global conversations about equitable healthcare access. The organization, which focuses on sexual and reproductive health rights, advocates for policies that prioritize women’s autonomy, safety, and informed decision-making. 'Healthcare is not just about availability—it’s about accessibility, affordability, and respect,' Peters concluded.
The findings also reflect the challenges of Nigeria’s broader healthcare landscape, where maternal mortality rates remain high and access to quality care is uneven. As the nation grapples with these issues, the study serves as a call to action for policymakers, healthcare providers, and communities to collaborate on solutions that address the root causes of care avoidance.
By centering women’s experiences, the WEWIN report offers a roadmap for building a health system that is not only functional but also human-centered. 'When women choose alternative pathways, it is not a failure of the system—it is an invitation to improve it,' Peters said. 'The goal must be to make the formal system the first, not the last, choice for those in need.'
The study’s release coincides with ongoing debates about healthcare reform in Nigeria, as stakeholders seek to balance resource constraints with the imperative to protect maternal and reproductive health. With over 2.1 million unvaccinated children and persistent gaps in primary care, the need for systemic change has never been more urgent.