Opinion: Women’s voices reveal a maternal medicines access gap

A woman in labor getting turned away from a health facility. Women being asked to purchase lifesaving medicines themselves before receiving care.

These are just some of the experiences captured in new research from global impact measurement company 60 Decibels, supported with funding from MSD for Mothers, which spoke to over 2,000 women in Kenya and Nigeria. By hearing directly from women who recently gave birth, the study highlights their real-world experiences across diverse settings.

The insights paint a clear picture: While many women report receiving respectful and timely care, too many are expected to find and fund key maternal health medicines — such as antibiotics, pain relief, and oxytocin, which is used to prevent and treat postpartum hemorrhage, or PPH — themselves.

The burden this places on women during childbirth demonstrates critical gaps in the health system’s ability to deliver complete care.

Financial protection is key to advancing maternal health

Achieving financial protection is a central pillar of the universal health coverage, or UHC agenda. Yet the promise of limiting individuals’ exposure to out-of-pocket spending on health care remains out of reach for far too many women giving birth.

Nearly 3 in 4 women interviewed reported paying out of pocket for maternal health medicines. Nearly 25% of women in Kenya and 37% of women in Nigeria borrow funds from friends or family to help cover the costs. Only 8% of women in Kenya and 6% in Nigeria reported having insurance that covered maternal health medicines.

This burden highlights the financial strain many women face in accessing essential maternal medicines, which can limit their access to overall care.

What can be done? One solution is for national health systems to integrate maternal health medicines into national financing schemes — such as insurance, vouchers, or subsidies. Their availability can be tracked at the point of care to make these commodities visible within health system performance metrics. Essential maternal medicines should also be treated as core benchmarks of UHC. Recent global efforts, such as the work of Every Woman Every Newborn Everywhere, or EWENE, are supporting countries in prioritizing maternal and newborn health commodities.

Enabling greater provider accountability

Cost is only part of the challenge. According to the study, 73% of women in Kenya were asked to procure their own maternal health medicines. In Nigeria, that number rose to 94%.

Most women reported receiving a prescription and then being left to navigate pharmacies lacking stocks, long travel distances to source medicines, and unpredictable costs, often while already in labor. One in 4 women visited more than one pharmacy to get the medicines they needed. Some reported going to six or seven.

In Kenya, 24% of women and in Nigeria, 27% of women could not get all the required medicines at a single pharmacy. One in five Nigerian women also reported challenges acquiring maternal health commodities, including high costs and unavailability.

What can be done? Health systems need to equip front-line providers with the tools they need to deliver quality care, including access to reporting mechanisms, quality-assured medicines, digital systems, and enabling environments. Safe, nonpunitive reporting channels for stock shortages and quality concerns are essential, allowing providers to feel supported when raising issues that affect patient care.

Facilities can also benefit from digital dashboards that link supply, inventory, and consumption data in real time — helping providers flag gaps faster, restock more efficiently, and advocate for the resources they need. Lifesaving medicines should be consistently available within health facilities — at the point of care — rather than only in external pharmacies, where availability can be unpredictable.

Self-procurement doesn’t guarantee quality

According to the study, 85% of women in Kenya and 55% in Nigeria reported purchasing maternal health medicines from private pharmacies or clinics. While many cited better stock, cleaner environments, and greater confidence in availability as reasons for bypassing public options, this does not guarantee quality.

Global evidence shows that medicine quality — particularly for maternal health — remains inconsistent across both public and private supply chains. The World Health Organization estimates that 10% of medical products in low- and middle-income countries, or LMICs, are substandard or falsified. For maternal health medicines, failure rates are even higher: nearly 40% of oxytocin and misoprostol have failed quality tests, often due to poor manufacturing, improper storage, or degradation.

What can be done? To support women’s health, quality must be a priority — no matter where they seek care. Public health facilities must be consistently stocked with quality-assured medicines to reduce reliance on self-procurement. At the same time, regulatory systems must extend to private pharmacies to ensure the availability of safe, quality-assured options.

Procurement agencies and national regulators should coordinate commodity purchases, batch testing, supplier audits, and cold-chain oversight. Regulatory authorities must be equipped to conduct inspections, randomly sample, and monitor medicines. Strengthened pharmacovigilance and hybrid public-private delivery models, supported by quality safeguards, can help close the gap and restore confidence at every point of care.

Hopeful momentum: Addressing gaps commonly faced by women in LMICs

The barriers women face in Kenya and Nigeria, unfortunately, persist around the world. Across LMICs, access to maternal health medicines still depends on where a woman gives birth, whether the facility is stocked with quality medicines, and whether she or her family can afford them. These challenges are most visible during labor and delivery — when delays can be life-threatening — but are rooted in systemic gaps: weak supply chains, uneven medicine availability, and poor integration into health financing and monitoring systems.

While challenges are significant, solutions are within reach. Elevating the voices and experiences of women helps to surface real-world barriers and shape more responsive solutions. By capturing both qualitative stories and quantitative trends, these insights inform national and global action.

Initiatives such as the United Nations Population Fund’s Maternal Health Thematic Fund, UNITAID’s programs to expand access to new and less common PPH medicines, and the Global Financing Facility’s co-investments are working alongside governments to improve forecasting, procurement, and last-mile delivery of lifesaving medicines. Within the EWENE platform, the Health Products Working Group seeks to support countries to scale up access to lifesaving maternal and newborn commodities. UNFPA’s Procurement Services Branch, UNITAID, and other global partners are helping to strengthen supply chains, improve affordability, and expand reliable access to essential medicines where women seek care.

These medicines are often the decisive factor between prevention and complications. Yet their reliable, quality-assured access remains an afterthought in too many maternal health strategies.

Health systems must work to make quality-assured essential maternal medicines reliably available — from upstream procurement to last-mile delivery.

Read the full report from 60 Decibels here.

The Funding the Future series is supported by funding from MSD, through its MSD for Mothers program, and is the sole responsibility of the authors. MSD for Mothers is an initiative of Merck & Co. Inc., in Kenilworth, N.J., U.S.

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