Midwives' challenges in northern Nigeria – in pictures

Northern Nigeria's maternal newborn and child health programme aims to help save the lives of at least 50,000 women during pregnancy and childbirth and 250, 000 newborn babies by 2015 Photograph: Lindsay Mgbor/DFID

Binta, 45, is a midwife in Katsina state in northern Nigeria. She travels to rural communities to teach women the early warning signs of a difficult pregnancy and childbirth Photograph: Lindsay Mgbor/DFID

Pregnant women in isolated rural communities are particularly vulnerable. Often their husbands are away trying to find work, leaving them with little support. Many have to give birth at home without medical assistance Photograph: Lindsay Mgbor/DFID

Binta teaches mothers' helpers who live in rural communities eight key signs of a difficult pregnancy and childbirth, and actions to help remember them. Fatsuma, 40, crosses her arms – the action for fever Photograph: Lindsay Mgbor/DfID

Fatsuma, who is a mothers' helper, counts either side of each knuckle to help women remember the number of symptoms, as well as learn different actions to match. Over 80% of women in northern Nigeria are illiterate and this helps them remember the information without the use of leaflets Photograph: Lindsay Mgbor/DfID

After suffering two stillbirths at home in Rogogo community, Katsina, Hauwa'u, 25, gave birth safely to a baby boy, Muktar, who is now five months old. Fatsuma had recognised a fever – one of the key danger signs – and got Hauwa'u to a hospital where she gave birth with the help of a midwife Photograph: Lindsay Mgbor/DfID

But women still face serious challenges during childbirth. Hadiza, 15, from Yanduna community, Katsina, lost her baby and nearly lost her life when, after displaying clear signs of danger, she was not taken to hospital and instead gave birth at her parents' home Photograph: DFID

Hadiza continued to bleed and her family gave her a traditional remedy. They prayed for her, writing inscriptions on tablets, washing them clean and giving her the water to drink Photograph: Lindsay Mgbor/DFID

It was only when Binta persuaded Hadiza's father to take her to hospital that she received the emergency medical care she needed to save her life. Hadiza's whole community is now involved with the programme through volunteer groups. Musabhu Yusif, the lead male volunteer, says, 'Now, the moment we know a woman is in labour, we will quickly go get transport and rush her to hospital' Photograph: Lindsay Mgbor/DFID

The maternity facilities at Daura hospital in Katsina state Photograph: Lindsay Mgbor/DFID

The community now has a saving scheme to which people contribute small amounts. This is used to cover the transport costs of getting pregnant women to a medical facility Photograph: Lindsay Mgbor/DFID

Engaging male volunteer groups in the importance of giving birth in medical facilities means more women are allowed to go to hospital, which had previously been seen as a bad thing by some in the community Photograph: DFID

'It's not only the volunteers who are transmitting this information, it's the whole community. One person will learn and then 10 or 20 people will learn from them,' says Binta Photograph: Lindsay Mgbor/DFID

The programme aims to reduce maternal deaths by one third by increasing the number of health workers in Nigeria, providing contraceptives and improving maternal care for millions of mothers Photograph: Lindsay Mgbor/DFID

Hauwa'u's dream now is that one day her daughter will become a health worker: 'I want her to become a nurse. I pray she will help others in the same way I have been helped' Photograph: Lindsay Mgbor/DFID

The G8's 2010 Muskoka initiative set clear targets in support of millennium development goals 4 and 5: i) reduce by two-thirds between 1990 and 2015, the under-five mortality rate ii) reduce by three-quarters, the maternal mortality ratio iii) achieve, by 2015, universal access to reproductive health. As the agreement states: 'Reaching these overall targets requires a major, sustained global effort .... ' See MDG data reports to monitor progress Photograph: Lindsay Mgbor/DFID