Reducing Indirect Causes of Maternal Morbidity and Mortality (RICOM3)

Timeline: October 2018 – December 2022 | Status: Completed

Lagos State and the Federal Capital Territory (FCT), Nigeria

Project Overview

While significant progress has been made in addressing direct causes of maternal mortality, many women continue to face life-threatening complications arising from underlying medical conditions during pregnancy. Conditions such as hypertension, diabetes, cardiac disease, and other non-obstetric illnesses can significantly increase the risk of severe maternal outcomes when not identified and managed appropriately.

To address this challenge, the Health Strategy and Delivery Foundation (HSDF), with support from Merck for Mothers, implemented the Reducing Indirect Causes of Maternal Morbidity and Mortality (RICOM3) programme between 2018 and 2022.

Implemented across Lagos State and the Federal Capital Territory (FCT), the programme sought to strengthen health systems' capacity to prevent, detect, and manage indirect causes of maternal morbidity and mortality. Through a combination of health systems strengthening, provider capacity development, stakeholder engagement, and quality improvement interventions, RICOM3 worked to ensure that women with underlying medical conditions received timely and appropriate care throughout pregnancy and childbirth.

Building on lessons from its initial phase, the programme expanded and deepened its interventions over time, supporting a more integrated approach to maternal healthcare and reinforcing the importance of multidisciplinary care for high-risk pregnancies.

Maternal mortality remains a major public health concern in Nigeria, with indirect medical conditions contributing significantly to preventable maternal deaths and severe complications.

Historically, maternal health interventions have focused largely on direct obstetric causes such as haemorrhage, sepsis, and obstructed labour. However, many women enter pregnancy with pre-existing health conditions that may worsen during pregnancy or complicate childbirth. Weak screening systems, delayed diagnosis, fragmented referral pathways, and limited provider capacity often make these risks more difficult to manage.

Addressing indirect causes of maternal mortality requires a health system capable of delivering coordinated, patient-centred care across different levels of service delivery.

HSDF worked closely with health institutions, professional associations, government stakeholders, and healthcare providers to strengthen maternal health services and improve the management of high-risk pregnancies. The programme focused on:

Strengthening the identification and management of indirect medical conditions during pregnancy.
Building the capacity of healthcare providers to deliver evidence-based maternal care.
Improving referral and care coordination systems for high-risk patients.
Supporting quality improvement initiatives within maternal health services.
Promoting multidisciplinary approaches to maternal healthcare delivery.
Generating evidence and lessons to inform maternal health policy and practice.

RICOM3 contributed to broader efforts to improve maternal health outcomes by drawing attention to the often-overlooked role of indirect medical conditions in maternal mortality. The programme helped strengthen clinical capacity, improve awareness of maternal risk factors, and support more coordinated care for pregnant women with complex health needs.

By fostering collaboration among healthcare providers and institutions, the initiative reinforced the importance of integrated maternal healthcare and helped advance conversations around improving the quality and safety of maternal services in Nigeria.